Abstract 6174: Primary Percutaneous Coronary Intervention Door-to-Balloon Time and Mortality in Patients Hospitalized with ST-Elevation Myocardial Infarction: Is 90 Minutes Fast Enough?
Hospitals seek to achieve door-to-balloon (DTB) times ≤90 minutes for patients undergoing primary percutaneous coronary intervention (PCI) for ST-elevation MI (STEMI). There are few data, however, regarding the incremental mortality benefit of reductions in DTB times under 90 minutes. The ACC National Cardiovascular Data Registry was used to assess the association between DTB and mortality in STEMI patients undergoing primary PCI during 2005–06. We restricted analysis to patients who received primary PCI as their initial reperfusion strategy, were treated at centers that performed ≥5 primary PCIs annually, and reported DTB times between 15 minutes and 6 hours (n=43801). Logistic regression models with fractional polynomials for time were used to assess the unadjusted association between DTB time and in-hospital mortality. Analyses were repeated adjusting for patient age, race, sex, symptoms, admission presentation, medical history, and hospital PCI volume. Median DTB time was 83 minutes. Overall mortality was 4.6%. Multivariable logistic regression models indicated any increase in DTB time was associated with successive increases in patients’ adjusted risk of in-hospital mortality. A reduction in DTB time from 90 minutes to 60 minutes was associated with a 0.8% reduction in mortality, and 60 minutes to 30 minutes with a 0.5% reduction, on average (Figure⇓). Our findings suggest any delay in primary PCI is associated with higher in-hospital mortality in patients hospitalized with STEMI. Efforts should focus on reducing DTB time as much as possible, even among those centers currently providing primary PCI within 90 minutes.