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Effect of Door-to-Balloon Time on Mortality in Patients With ST-Segment Elevation Myocardial Infarction

Robert L. McNamara, MD, MHS^_*, Yongfei Wang, MS^_*, Jeph Herrin, PhD^_*, Jeptha P. Curtis, MD^_*, Elizabeth H. Bradley, PhD, David J. Magid, MD, MPH^,||, Eric D. Peterson, MD, MPH^¶, Martha Blaney, PharmD^#,1, Paul D. Frederick, PhD^_**, Harlan M. Krumholz, MD, SM^_*,,,,_* for the NRMI Investigators

^_* Department of Medicine, Section of Cardiovascular Medicine
Department of Epidemiology and Public Health, Section of Health Policy and Administration
Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, Connecticut
Clinical Research Unit, Kaiser Permanente, Denver, Colorado
^|| Departments of Emergency Medicine and Preventive Medicine and Biometrics, University of Colorado Health Sciences Center, Denver, Colorado
^¶ Duke Clinical Research Institute, Duke University, Durham, North Carolina
^# Genentech Inc., South San Francisco, California
^_** Ovation Research Group, Seattle, Washington
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut

View larger version (11K): [in a new window]   Figure 1 In-hospital mortality and door-to-balloon time; p for trend < 0.001.

View larger version (24K): [in a new window]   Figure 2 In-hospital mortality and door-to-balloon time in patients stratified by symptom onset-to-door time; p for trend < 0.001 for each line.

View larger version (14K): [in a new window]   Figure 3 In-hospital mortality and door-to-balloon time in patients stratified by risk factor status; p for trend < 0.001 for each line. Risk factors include anterior/septal location, diabetes mellitus, heart rate >100 beats/min, systolic blood pressure <100 mm Hg.

View larger version (19K): [in a new window]   Figure 4 Independent effect of door-to-balloon time on in-hospital mortality in subgroups by (A) symptom onset-to-door time and (B) risk factor status. Reference group: door-to-balloon time <90 min. DTB = door-to-balloon; MI = myocardial infarction; SBP = systolic blood pressure.