Abstract 18589: The Impact of a Door-to-Balloon Time of Less Than 30 Minutes on the In-Hospital Prognosis of Patients With ST Elevation Myocardial Infarction
Introduction: Several recent studies suggested that the door-to-balloon time (DTBT) for patients with ST elevation myocardial infarction (STEMI) should be as short as possible, even in centers currently providing percutaneous coronary intervention within 90 min. However, these studies have been conducted with a relatively small proportion of patients who were treated with a shorter (<30 min) DTBT.
Objectives: In this study, we sought to evaluate the clinical outcome of a DTBT of as short as ≤30 min in a higher proportion of patients than that in recent studies, because of the effort to reduce the DTBT.
Methods and Results: We evaluated 527 consecutive patients with STEMI who underwent primary coronary intervention (PCI) between 2007 and 2015. Their mean age was 68.0 ± 12.7 years, and the mean DTBT was 28.4 ± 28.1 min. DTBT within 90 min was achieved in 503 patients (95.4%). The patients were classified into four groups according to DTBT, and the relationship between DTBT and clinical outcome was investigated. The trans-radial approach was performed in 494 patients (93.7%). The DTBT was ≤30 min in 146 patients, 31-60 min in 297 patients, 61-90 min in 60 patients, and >90 min in 24 patients. The in-hospital mortality rate was 0.7%, 5.0%, 11.7%, and 12.5% for DTBT of ≤30, 31-60, 61-90, and >90 min, respectively (DTBT 31-60 min: odds ratio [OR] 10.30, 95% confidence interval [CI] 1.04-103.00, p = 0.046; 61-90 min: OR 13.50, 95% CI 1.14-160.00, p = 0.039; >90 min: OR 25.00, 95% CI 1.64-381.00, p = 0.021, compared with DTBT ≤30 min on multivariate analysis). The peak creatine phosphokinase levels were 2218 ± 2126, 2578 ± 2241, 2997 ± 2857, and 1273 ± 1139 IU/L, respectively.
Conclusions: Although the guidelines recommended a DTBT of within 90 min in PCI for STEMI patients, patients treated with DTBT within 30 min showed significantly better clinical outcomes than did patients treated with DTBT from 30 to 90 min. The effort to achieve a shorter DTBT contributed to lower in-hospital mortality in patients with STEMI, especially when the DTBT was ≤30 min.
Author Disclosures: T. Yamada: None. A. Takahashi: None. Y. Mizuguchi: None. H. Shibutani: None. S. Hashimoto: None. N. Taniguchi: None. S. Nakajima: None. T. Hata: None.
- © 2016 by American Heart Association, Inc.