Key result
Door-to-balloon time over 60 minutes is linked to ~69% higher 3-year mortality in high-risk STEMI.
Why the study?
Current guidelines diverge on the optimal door-to-balloon time for STEMI, and whether a ≤60 min target benefits all patients equally remains unclear.
Does a door-to-balloon time ≤60 minutes improve short- and long-term outcomes in patients with STEMI undergoing primary PCI?
Cohort (n=4,513)
No
Does a door-to-balloon time ≤60 minutes improve short- and long-term outcomes in patients with STEMI undergoing primary PCI?
Hazard Ratio: 1.689 (95% CI 1.267–2.253)
Absolute Event Rate: 11.6% vs 6.9%
p-value: p=<0.001
Achieving a door-to-balloon time of ≤60 minutes significantly reduces short- and long-term mortality in high-risk STEMI patients (GRACE >140), but may not provide the same prognostic benefit in low-risk patients.
Supports targeting door-to-balloon ≤60 min in high-risk STEMI; leaves open causal confirmation and benefit in lower-risk groups.
BACKGROUND: Current guidelines diverge on the optimal door-to-balloon time (DTBT) for acute ST-segment elevation myocardial infarction (STEMI), and whether a ≤60 min target benefits all patients equally remains unclear. OBJECTIVES: This study aimed to investigate whether the association between DTBT ≤60 min and short- and long-term prognosis in STEMI patients varies by Global Registry of Acute Coronary Events (GRACE) risk score. DESIGN: Retrospective cohort study. SETTING: Single high-volume tertiary cardiology centre in China. PARTICIPANTS: This study initially included 5516 STEMI patients undergoing primary percutaneous coronary intervention (PPCI) treatment. 4513 were included after applying inclusion criteria (age >18 years, presentation within 12 hours of symptom onset, complete medical records) and exclusion criteria (symptom duration ≥12 hours, failure to receive PPCI, incomplete outcome data). INTERVENTIONS: Not applicable (observational study). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were in-hospital, 1-year and 3-year all-cause mortality. Secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE) at 1 and 3 years post-discharge. RESULTS: Among 4513 STEMI patients, 2433 (54.0%) were high-risk (HR-STEMI) and 2080 (46.0%) low-risk (LR-STEMI). DTBT ≤60 min was achieved in 45.7% of HR-STEMI and 52.0% of LR-STEMI patients. For HR-STEMI patients, DTBT >60 min was associated with significantly higher risks of in-hospital mortality (OR=2.381, 95% CI 1.160 to 4.883, p=0.018), 1-year mortality (HR=1.715, 95% CI 1.194 to 2.464, p=0.003), 1-year MACCE (HR=1.212, 95% CI 1.001 to 1.467, p=0.049), 3-year mortality (HR=1.689, 95% CI 1.267 to 2.253, p<0.001), and 3-year MACCE (HR=1.230, 95% CI 1.042 to 1.453, p=0.014). Among LR-STEMI patients, no significant differences were observed between DTBT groups. CONCLUSIONS: DTBT ≤60 min was significantly associated with better short- and long-term outcomes, particularly in patients with GRACE >140. Sensitivity analysis suggested that the benefit may also extend to patients with GRACE scores between 120 and 140. TRIAL REGISTRATION NUMBER: Not applicable (observational study).
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Wang et al. (2026) conducted a cohort in ST-segment elevation myocardial infarction (n=4,513). Door-to-balloon time >60 minutes vs. Door-to-balloon time ≤60 minutes was evaluated on 3-year all-cause mortality in high-risk STEMI patients (HR 1.689, 95% CI 1.267 to 2.253, p=<0.001). In high-risk STEMI patients, a door-to-balloon time >60 minutes was associated with a significantly higher risk of 3-year all-cause mortality (HR 1.689) compared to a time of ≤60 minutes.
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