Abstract 1291: Reducing Door to Balloon Time in Patients With ST-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention: Does a Decrease in Door to Balloon Time Translate Into a Reduction in Mortality?
Background: In patients with acute ST-elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), current guidelines for reperfusion therapy recommend door to balloon (DTB) time of less than 90 minutes, and this standard is used as a quality indicator for hospitals nationally. Considerable effort has focused on reducing DTB time with the assumption that a reduction in DTB time translates into a marked reduction in mortality. However, the clinical impact of this effort has not been evaluated.
Methods: We assessed the temporal trend in DTB time for 8770 STEMI patients undergoing primary PCI from 2003–08 as part of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium to determine if there has been a corresponding reduction in mortality. The analysis was restricted to patients presenting within 12 hours of symptom onset, and primary endpoint was in-hospital death.
Results: Median DTB time has decreased dramatically from 2003 to 2008 with an over 100% increase in the percentage of patients meeting the current guideline of DTB time less than 90 minutes (28.5% , 38.3% , 42.5% , 50.7% , 62.0% , 67.2% , p<0.0001). Despite a decrease in median DTB time, the overall mortality was unchanged (4.10% , 4.02% , 4.40% , 4.42% , 4.73% , 3.62% , p=0.69), as shown in Figure 1⇓.
Conclusions: Our analysis shows that despite dramatic improvement in median DTB times, overall mortality of patients undergoing PCI for STEMI remains unchanged. Further research is warranted to assess the lack of improvement in survival despite dramatic improvements in DTB time.