Coronary artery disease
Effect of Onset-to-Door Time and Door-to-Balloon Time on Mortality in Patients Undergoing Percutaneous Coronary Interventions for ST-Segment Elevation Myocardial Infarction

https://doi.org/10.1016/j.amjcard.2010.02.029Get rights and content

It is important to identify the factors related to survival of patients undergoing primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction. Our objective was to determine the interactive effect of the door-to-balloon (DTB) time and onset-to-door (OTD) time on longer term mortality for patients with ST-segment elevation acute myocardial infarction. The present study was a retrospective cohort analysis of the effect of the DTB time and OTD time on longer term (median follow-up 413 days) mortality for patients undergoing primary percutaneous coronary intervention in New York from January 1, 2004 to December 31, 2006, adjusting for the effect of other important risk factors. The patients with ST-segment elevation acute myocardial infarction with a DTB time of <90 minutes and OTD time of <4 hours had the lowest longer term mortality (3.51%). Patients with a DTB time <90 minutes and OTD time of ≥4 hours had significantly greater mortality than patients with an OTD time of <4 hours and DTB time of <90 minutes (adjusted hazard ratio 1.54, 95% confidence interval 1.04 to 2.30), as did patients with a DTB time of ≥90 minutes and OTD time of ≥4 hours (adjusted hazard ratio 1.48, 95% confidence interval 1.05 to 2.09). For an OTD time of <4 hours and DTB time of ≥90 minutes, mortality showed a trend toward being greater compared to shorter OTD and DTB times (adjusted hazard ratio 1.29, 95% confidence interval 0.95 to 1.77). In conclusion, the combination of short (<90 minutes) DTB time and short (<4 hours) OTD time was associated with the lowest longer term mortality rate.

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Methods

The main database used in the present study was the New York State Percutaneous Coronary Intervention Reporting System registry, which was developed in 1991 for the purpose of collecting information on all patients undergoing percutaneous coronary intervention (PCI) in New York's nonfederal hospitals. Deaths occurring among New York State patients after discharge from the hospital were obtained by matching the Percutaneous Coronary Intervention Reporting System to New York's Vital Statistics

Results

Table 1 lists the patient risk factors stratified by the DTB time (<90 minutes) and OTD time (<4 hours). The median follow-up period was 413 days. As indicated in Table 1, 2,368 patients (46.5%) had a DTB time of <90 minutes and 4,092 patients (88.9%) had an OTD time of <4 hours; 1,878 patients (36.9%) had both an OTD time of <4 hours and a DTB time of <90 minutes.

Significant differences were found among the DTB time and OTD time groups for many patient risk factors. Older patients, black

Discussion

The time from the onset of symptoms to balloon time, which is the OTD time plus the DTB time, has been hypothesized to be an important determinant of patient outcomes, and a variety of studies have examined the effect of this interval or subsets of it on patient outcomes.2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12

Our study explored the combined effect of DTB time and OTD time on longer term mortality for patients with STEMI undergoing primary PCI in a large region (New York State). We found that women,

Acknowledgment

We thank the New York State Cardiac Advisory Committee for their encouragement and support of this study; and Paula Waselauskas, Kimberly Cozzens, Cynthia Johnson, and the cardiac catheterization laboratories of the participating hospitals for their tireless efforts to ensure the timeliness, completeness, and accuracy of the registry data. We also acknowledge that some of the information contained in our study was derived from data provided by the Bureau of Vital Statistics, New York City

References (17)

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