Shorter door-to-balloon time (<45 min) in STEMI patients undergoing PPCI was associated with a lower 3-year primary composite endpoint rate (10.2% vs 15.3%, 16.2%, and 19.3%; p=0.0129).
Cohort (n=1,639)
Yes
Does shorter door-to-balloon time improve long-term clinical outcomes in STEMI patients treated with primary PCI?
Shorter door-to-balloon time is associated with significantly better long-term clinical outcomes up to 3 years in STEMI patients undergoing primary PCI.
Absolute Event Rate: 10.2% vs 19.3%
p-value: p=0.0129
BACKGROUND: The impact of shorter door-to-balloon (DTB time on long-term outcomes in ST-segment elevation myocardial infarction (STEMI treated with primary percutaneous coronary intervention (PPCI has not been fully elucidated. METHODS: We investigated 3283 consecutive patients with acute myocardial infarction selected from a prospective, nationwide, multicenter registry (J-MINUET database comprising 28 institutions in Japan between July 2012 and March 2014. Among the study population, we analyzed 1639 STEMI patients who had PPCI within 12 h of onset. Patients were stratified into four groups (DTB time 90 min. The primary endpoint was a composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure, and urgent revascularization for unstable angina up to 3 years. We performed landmark analysis for incidence of the primary endpoint from 31 days to 3 years among the four groups. RESULTS: The primary endpoint rate from 31 days to 3 years increased significantly and time-dependently with DTB time (10.2 % vs. 15.3 % vs. 16.2 % vs. 19.3 %, respectively; log-rank p = 0.0129. Higher logarithm-transformed DTB time was associated with greater risk of a primary endpoint from 31 days to 3 years, and the increased number of adverse long-term clinical outcomes persisted even after adjusting for other independent variables. CONCLUSION: Shorter DTB time was associated with better long-term clinical outcomes in STEMI patients treated with PPCI in contemporary clinical practice. Further efforts to shorten DTB time are recommended to improve long-term clinical outcomes in STEMI patients. TRIAL REGISTRATION: UMIN Unique trial Number: UMIN000010037.
Nishio et al. (Thu,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=1,639). Door-to-balloon time < 45 min vs. Door-to-balloon time > 90 min was evaluated on Composite of all-cause death, non-fatal MI, non-fatal stroke, cardiac failure, and urgent revascularization for unstable angina up to 3 years (p=0.0129). Shorter door-to-balloon time (<45 min) in STEMI patients undergoing PPCI was associated with a lower 3-year primary composite endpoint rate (10.2% vs 15.3%, 16.2%, and 19.3%; p=0.0129).
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