Door-To-Balloon Time and In-Hospital Outcomes in Age-Stratified Patients with St-Elevation Myocardial Infarction

Q: What is the clinical evidence from this study?

Study design: Observational. Population: ST-elevation myocardial infarction (STEMI) (n=110). Intervention: Door-to-balloon time >90 minutes vs. Door-to-balloon time ≤90 minutes. Primary outcome: In-hospital mortality (p=0.004).

Q: What does this research mean for the field?

In STEMI patients undergoing primary percutaneous coronary intervention, door-to-balloon time greater than 90 minutes and advancing age are both significantly associated with higher in-hospital mortality and major adverse cardiovascular events. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Jwala Kumar; Ravi Vishnu Prasad; Sanjita; Chandra Bhanu Chandan

doi:10.32553/ijmbs.v10i9.3454

September 30, 2026International Journal of Medical and Biomedical StudiesOpen Access

Door-To-Balloon Time and In-Hospital Outcomes in Age-Stratified Patients with St-Elevation Myocardial Infarction

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Key result

Door-to-balloon time >90 minutes linked to ~4-fold higher in-hospital mortality in STEMI.

P=0.004
n=110

Why the study?

The relationship between door-to-balloon time and clinical outcomes after primary percutaneous coronary intervention for STEMI may differ according to age, particularly among elderly and very elderly patients.

Does a shorter door-to-balloon time (≤90 minutes) reduce in-hospital mortality and major adverse cardiovascular events in age-stratified patients with STEMI undergoing primary percutaneous coronary intervention?

Study Design

Type

Observational (n=110)

Multicenter

No

Structured PICO

Does a shorter door-to-balloon time (≤90 minutes) reduce in-hospital mortality and major adverse cardiovascular events in age-stratified patients with STEMI undergoing primary percutaneous coronary intervention?

P

Population

110 consecutive adult patients (mean age 67.1 years, 29.1% female) presenting with acute STEMI without prior fibrinolysis who underwent primary PCI at a single tertiary-care center in India and were followed during hospitalization.

E

Exposure

Primary percutaneous coronary intervention (PPCI) stratified by door-to-balloon time (DTBT ≤90 minutes vs. >90 minutes) and age group (<75 years, 75–84 years, ≥85 years)

C

Comparator

Door-to-balloon time ≤90 minutes vs. >90 minutes, and comparison across age groups (<75 years vs. 75–84 years vs. ≥85 years)

O

Outcome

In-hospital mortalityhard clinical

Main Result

Absolute Event Rate: 26.5% vs 6.6%

p-value: p=0.004

In STEMI patients undergoing primary PCI, advancing age is associated with longer door-to-balloon times, and delays exceeding 90 minutes are associated with a fourfold increase in in-hospital mortality and higher rates of MACE.

Limitations

Single tertiary-care centre design, which may limit generalizability to other institutions and healthcare systems.
Relatively small sample size, particularly in the ≥85-year age group (n=14).
Observational design permits identification of associations but cannot establish a causal relationship between DTBT and mortality.
Unmeasured or unadjusted potential confounders including frailty, symptom-to-door time, prehospital delay, renal function, infarct severity, Killip class, and coronary anatomy.
Lack of a fully adjusted multivariable regression model examining the independent association between DTBT and mortality.
MACE definition included death and complications related to baseline clinical severity, meaning MACE and mortality were not mutually independent.
Relatively small number of patients in the ≥85-year group (n=14)
Observational design that did not formally evaluate the specific causes of treatment delay
Association between DTBT and outcomes does not prove a direct causal relationship due to potential confounding by clinical instability or complex anatomy

Implication

May support minimizing door-to-balloon time in STEMI; leaves open whether age-specific targets improve outcomes in the very elderly.

Abstract

Background: Timely reperfusion with primary percutaneous coronary intervention (PPCI) is a cornerstone of treatment for ST-elevation myocardial infarction (STEMI). Door-to-balloon time (DTBT) is an important measure of the efficiency of in-hospital reperfusion. However, the relationship between DTBT and clinical outcomes may differ according to age, particularly among elderly and very elderly patients. Aim: To evaluate the relationship between door-to-balloon time and clinical outcomes among patients with STEMI undergoing primary percutaneous coronary intervention, with particular emphasis on patients aged <75 years, 75–84 years, and ?85 years. Materials and Methods: A hospital-based observational study was conducted among 110 consecutive adult patients with STEMI undergoing PPCI at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India, over a one-year study period from January 2025 to December 2025. Patients were categorized into three age groups: <75 years, 75–84 years, and ?85 years. Demographic characteristics, cardiovascular risk factors, clinical presentation, Killip class, left ventricular ejection fraction, DTBT, angiographic findings, procedural characteristics, and in-hospital outcomes were recorded. DTBT was categorized as ?90 minutes or >90 minutes. The primary outcome was in-hospital mortality. Secondary outcomes included major adverse cardiovascular events (MACE), cardiogenic shock, acute heart failure, clinically significant arrhythmia, stroke, and major bleeding. Categorical and continuous variables were analyzed using appropriate statistical tests. A two-sided p-value <0.05 was considered statistically significant. Results: Among the 110 patients, 68 (61.8%) were aged <75 years, 28 (25.5%) were aged 75–84 years, and 14 (12.7%) were aged ?85 years. The mean age was 67.1 ± 13.2 years. DTBT ?90 minutes was achieved in 76 (69.1%) patients. Mean DTBT increased progressively across the age groups, from 67.8 ± 24.6 minutes in patients aged <75 years to 78.6 ± 31.4 minutes among those aged 75–84 years and 92.3 ± 36.8 minutes among those aged ?85 years (p=0.004). In-hospital mortality increased from 5.9% in the <75-year group to 17.9% in the 75–84-year group and 35.7% in the ?85-year group (p=0.006). MACE occurred in 14.7%, 32.1%, and 50.0% of patients, respectively (p=0.009). Patients with DTBT >90 minutes had higher in-hospital mortality than those treated within 90 minutes (26.5% vs. 6.6%, p=0.004). MACE was also more frequent among patients with DTBT >90 minutes (41.2% vs. 15.8%, p=0.004). Conclusion: Increasing age was associated with longer door-to-balloon time and progressively poorer clinical outcomes after STEMI. DTBT >90 minutes was associated with higher in-hospital mortality and MACE. Efforts to minimize avoidable treatment delays should remain a priority across all age groups, with particular attention to elderly and very elderly patients.

Discussion

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Cite This Study

Kumar et al. (2026) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=110). Door-to-balloon time >90 minutes vs. Door-to-balloon time ≤90 minutes was evaluated on In-hospital mortality (p=0.004). Door-to-balloon time >90 minutes was associated with higher in-hospital mortality (26.5% vs. 6.6%, p=0.004) in STEMI patients undergoing primary PCI, with mortality increasing to 35.7% in patients ≥85 years (p=0.006).

synapsesocial.com/papers/6ae28e56cbadf70daf6c422a https://doi.org/10.32553/ijmbs.v10i9.3454

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Door-To-Balloon Time and In-Hospital Outcomes in Age-Stratified Patients with St-Elevation Myocardial Infarction

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Door-To-Balloon Time and In-Hospital Outcomes in Age-Stratified Patients with St-Elevation Myocardial Infarction

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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