CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
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
Bruce R. Brodie, MD, FACC*,*,
Charles Hansen, MA ,
Thomas D. Stuckey, MD, FACC*,
Scott Richter, PhD ,
Debra S. VerSteeg, RN*,
Navin Gupta, MD, FACC*,
William E. Downey, MD, FACC* and
Mark Pulsipher, MD, FACC*
* LeBauer Cardiovascular Research Foundation and the Moses Cone Heart and Vascular Center, Greensboro, North Carolina
Internal Medicine Residency Program, Moses H. Cone Memorial Hospital, Greensboro, North Carolina
Department of Mathematics, University of North Carolina at Greensboro, Greensboro, North Carolina
Manuscript received March 16, 2005;
revised manuscript received August 9, 2005,
accepted August 15, 2005.
* Reprint requests and correspondence: Dr. Bruce R. Brodie, 1126 North Church Street, Suite 300, Greensboro, North Carolina 27401. (Email: bbrodie{at}triad.rr.com).
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.
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Abbreviations and Acronyms
| | CADILLAC = Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications | | GUSTO = Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries | | NRMI = National Registry of Myocardial Infarction | | PAMI = Primary Angioplasty in Myocardial Infarction | | PCI = percutaneous coronary intervention | | STEMI = ST-segment elevation myocardial infarction | | TIMI = Thrombolysis In Myocardial Infarction |
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