Door-to-Balloon Time With Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction Impacts Late Cardiac Mortality in High-Risk Patients and Patients Presenting Early After the Onset of Symptoms

UNCG Author/Contributor (non-UNCG co-authors, if there are any, appear on document)
Scott J. Richter, Professor (Creator)
The University of North Carolina at Greensboro (UNCG )
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Abstract: OBJECTIVES The purpose of this study was to evaluate the impact of door-to-balloon time with primary percutaneous coronary intervention (PCI) on late cardiac mortality.

BACKGROUND The impact of door-to-balloon time on outcomes is controversial, and the impact on late mortality has not been studied.

METHODS Consecutive patients (n _ 2,322) treated with primary PCI from 1984 to 2003 were prospectively identified and followed up for a median of 83 months.

RESULTS Prolonged door-to-balloon times (0 to 1.4 h vs. 1.5 to 1.9 h vs. 2.0 to 2.9 h vs. _3.0 h) were associated with higher in-hospital mortality (4.9% vs. 6.1% vs. 8.0% vs. 12.2%, p _ 0.0001) and late mortality (12.6% vs. 16.4% vs. 20.4% vs. 27.1% at 7 years, p _ 0.0001) and were an independent predictor of late mortality by Cox regression (p _ 0.0004). Prolonged door-to-balloon times (_2 h vs. _2 h) were associated with higher late mortality in high-risk patients (32.5% vs. 21.5%; hazard ratio [HR], 1.53; 95% confidence interval [CI], 1.22 to 1.90; p _ 0.0002) but not in low-risk patients (10.8% vs. 9.2%; HR, 1.13; 95% CI, 0.78 to 1.64; p _ 0.53) and in patients presenting early (_3 h) (24.7% vs. 15.0%; HR, 1.54; 95% CI, 1.24 to 1.90; p _ 0.0001) but not late (_3 h) (21.1% vs. 18.5%; HR, 0.95; 95% CI, 0.62 to 1.45; p _ 0.80).

CONCLUSIONS Delays in door-to-balloon time impact late survival in high-risk but not low risk patients and in patients presenting early but not late after the onset of symptoms. These findings have implications for the triage of patients for primary PCI. (J Am Coll Cardiol 2006;47: 289–95)

Additional Information

Journal of the American College of Cardiology
Language: English
Date: 2006
primary percutaneous coronary intervention (PCI), door-to-balloon time, late cardiac mortality

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