Abstract 18556: Trends in Door-to-Balloon Time and Mortality in STEMI Patients Undergoing Primary PCI in Massachusetts
Background: Recognition that primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy for ST-elevation myocardial infarction (STEMI) if delivered in a timely fashion resulted in national efforts successful in reducing time to treatment. To determine whether the decreasing door-to-balloon (DTB) time is associated with a reduction in mortality, we evaluated 12,210 STEMI patients undergoing primary PCI in Massachusetts between 1/2005 and 9/2010.
Methods: We used prospectively collected data compiled, audited, and analyzed by the Massachusetts Data Analysis Center, the state mandated PCI registry.
Results: The mean age of the population was 61.9 years, with 29% women and 6.1% in cardiogenic shock. Between 2005 and 2010, median door-to-balloon time decreased from 85.0 to 67.5 minutes in patients presenting directly to PCI hospitals and from 153.5 to 113.0 minutes in patients requiring inter-hospital transfer for PCI. DTB time ≤90 minutes increased from 56.8% to 77.1% in patients presenting directly to PCI hospitals and from 4.3% to 23.4% in patients requiring inter-hospital transfer (Table). However, in-hospital and 30-day mortality during the study period did not significantly change (Figure).
Conclusion: DTB time has decreased for STEMI patients in Massachusetts and more patients are achieving the guideline-recommended DTB ≤ 90 minutes. Despite these improvements, in-hospital and 30-day mortality remain unchanged. The reason for the unexpected absence of a decrease in mortality will require further study.
- © 2012 by American Heart Association, Inc.