Relation of lowering door-to-balloon time and mortality in ST segment elevation myocardial infarction patients undergoing percutaneous coronary intervention.

Abstract

Current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommend a door-to-balloon time (DBT) of ≤ 90min for patients undergoing primary percutaneous coronary intervention (PCI). We aimed to investigate the possible impact of further reduction in DBT intervals beyond the 90min cutoff on short and long-term outcomes among STEMI patients undergoing primary PCI. We retrospectively studied 889 STEMI patients (median age 61 years, 83% men) who underwent successful primary PCI and had a DBT of ≤ 90min. Patients were stratified according to DBT into 2 groups: < 60min and 60-90min. Patients records were assessed for the occurrence of in-hospital complications, 30-day and 1-year mortality. Patients having DBT < 60min (n = 608, 68%) were more likely to present earlier, in daytime and weekdays, and had better post-procedural left ventricular ejection fraction and lower 30-day mortality (3% vs. 6%, p = 0.03). Mortality over 1-year was significantly lower among patients having DBT < 60 compared to DBT of 60-90min (4.6% vs. 9.6%, p = 0.004). In a binary logistic regression model DBT < 60min was associated with 51% risk reduction for 1-year mortality (OR 0.49, 95% CI 0.25-0.93, p = 0.03). Among STEMI patients undergoing primary PCI within 90min of admission DBT < 60min was independently associated with better 1-year mortality.