Abstract 13320: Age-Based Trends in Improvement in Door-to-Balloon Time Over 15 Years

Abstract

Background: In April 2004, an in-house 24x7 interventional cardiology program was implemented at our center to improve door-to-balloon time (D2BT) in ST-segment elevation myocardial infarction (STEMI). Data on our program published in 2010 showed improved D2BT along with improvement in major adverse cardiovascular events and mortality. Hypothesis: We hypothesized that the median D2BT has further improved over time in both elderly and young patients. Aims: The primary objective was to evaluate aged-based yearly trends in median D2BT in patients with STEMI since the implementation of the 24x7 program. Methods: We collected data on all non-transfer adult patients with STEMI at our center from April 1, 2004, to March 31, 2019. Median two-sample test was used to compare medians. Results: A total of 1,889 patients with STEMI (median age [IQR] of 61 [54-71] years, 31% female) were evaluated. Of these, 221 (11.7%) were aged ≥80 years and 1,668 (88.3%) were aged <80 years. Females made up 60% of the elderly group and 27% in the younger group. In the overall cohort, the median D2BT in patients aged >80 years was significantly higher than in the younger group (54 min vs. 49 min, P = 0.004). Temporal trends in the median D2BT are shown in the figure. There was a decreasing trend in median D2BT in both age groups, but D2BT remained longer for the older patients compared with the young for most of the study period. In patients aged <80 years, the median D2BT decreased from 68 minutes in 2004 to 45 minutes in 2019 (P trend < .001), and in patients aged ≥80 years, the median D2BT decreased from 81 minutes in 2004 to 68 minutes in 2019 (P trend = .016). Conclusion: Even though the national averages are beaten by our 24x7 program, D2BT remains higher in the elderly cohort. This is likely due to atypical presentation in elderly females, complexity of the decision-making process in the elderly, and frailty of elderly patients on presentation.