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;
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.
|
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 |
|
This article has been cited by other articles:
|
|
|
|
 
A. E. Denktas, H. Athar, T. D. Henry, D. M. Larson, M. Simons, R. S. Chan, N. W. Niles, H. Thiele, G. Schuler, C. Ahn, et al.
Reduced-Dose Fibrinolytic Acceleration of ST-Segment Elevation Myocardial Infarction Treatment Coupled With Urgent Percutaneous Coronary Intervention Compared to Primary Percutaneous Coronary Intervention Alone: Results of the AMICO (Alliance for Myocardial Infarction Care Optimization) Registry
J. Am. Coll. Cardiol. Intv.,
October 1, 2008;
1(5):
504 - 510.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Manari, P. Ortolani, P. Guastaroba, G. Casella, L. Vignali, E. Varani, G. Piovaccari, V. Guiducci, G. Percoco, S. Tondi, et al.
Clinical impact of an inter-hospital transfer strategy in patients with ST-elevation myocardial infarction undergoing primary angioplasty: the Emilia-Romagna ST-segment elevation acute myocardial infarction network
Eur. Heart J.,
August 1, 2008;
29(15):
1834 - 1842.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Stone
Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part I: Primary Percutaneous Coronary Intervention
Circulation,
July 29, 2008;
118(5):
538 - 551.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. G. Ellis, M. Tendera, M. A. de Belder, A. J. van Boven, P. Widimsky, L. Janssens, H.R. Andersen, A. Betriu, S. Savonitto, J. Adamus, et al.
Facilitated PCI in Patients with ST-Elevation Myocardial Infarction
N. Engl. J. Med.,
May 22, 2008;
358(21):
2205 - 2217.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M. Larson, K. M. Menssen, S. W. Sharkey, S. Duval, R. S. Schwartz, J. Harris, J. T. Meland, B. T. Unger, and T. D. Henry
"False-Positive" Cardiac Catheterization Laboratory Activation Among Patients With Suspected ST-Segment Elevation Myocardial Infarction
JAMA,
December 19, 2007;
298(23):
2754 - 2760.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. K. Nallamothu, E. H. Bradley, and H. M. Krumholz
Time to Treatment in Primary Percutaneous Coronary Intervention
N. Engl. J. Med.,
October 18, 2007;
357(16):
1631 - 1638.
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Dudek, T. Rakowski, A. Dziewierz, and W. Mielecki
Time delay in primary angioplasty: how relevant is it?
Heart,
October 1, 2007;
93(10):
1164 - 1166.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. E. Boden, K. Eagle, and C. B. Granger
Reperfusion Strategies in Acute ST-Segment Elevation Myocardial Infarction: A Comprehensive Review of Contemporary Management Options
J. Am. Coll. Cardiol.,
September 4, 2007;
50(10):
917 - 929.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. R. Dixon, C. L. Grines, and W. W. O'Neill
The Year in Interventional Cardiology
J. Am. Coll. Cardiol.,
July 17, 2007;
50(3):
270 - 285.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Sanz, R. W. Smalling, D. L. Brewer, W. J. French, L. A. Smaha, H. H. Ting, and D. E. Casey
Development of Systems of Care for ST-Elevation Myocardial Infarction Patients: The Physician Perspective
Circulation,
July 10, 2007;
116(2):
e39 - e42.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. de Villiers, T. Anderson, J. D. McMeekin, R. C.M. Leung, M. Traboulsi, and for the Foothills Interventional Cardiology Servic
Expedited transfer for primary percutaneous coronary intervention: a program evaluation
Can. Med. Assoc. J.,
June 19, 2007;
176(13):
1833 - 1838.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K.-H. Mak
Benefits of transfer primary angioplasty are durable, so why are we waiting?
Eur. Heart J.,
March 2, 2007;
28(6):
655 - 656.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. R. Brodie, C. L. Grines, and G. W. Stone
Effect of Door-to-Balloon Time on Patient Mortality
J. Am. Coll. Cardiol.,
December 19, 2006;
48(12):
2600 - 2600.
[Full Text]
[PDF]
|
|
|
|
|
|
|
T. Huynh, J. O'Loughlin, L. Joseph, E. Schampaert, S. Rinfret, M. Afilalo, S. Kouz, B. Cantin, M. Nguyen, M. J. Eisenberg, et al.
Delays to reperfusion therapy in acute ST-segment elevation myocardial infarction: results from the AMI-QUEBEC Study
Can. Med. Assoc. J.,
December 5, 2006;
175(12):
1527 - 1532.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Tarantini, R. Razzolini, and S. Iliceto
Interaction Among Risk-Time and Benefit of Primary Angioplasty
J. Am. Coll. Cardiol.,
September 5, 2006;
48(5):
1062 - 1062.
[Full Text]
[PDF]
|
|
|
|
|
|
|
B. R. Brodie, C. Hansen, T. D. Stuckey, S. Richter, D. S. VerSteeg, N. Gupta, W. E. Downey, and M. Pulsipher
Reply
J. Am. Coll. Cardiol.,
September 5, 2006;
48(5):
1062 - 1063.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. J. Walsh, C. G. Owens, and A. A. J. Adgey
Pre-hospital diagnosis of myocardial infarction: an opportunity to improve outcomes?
Eur. Heart J.,
July 1, 2006;
27(13):
1515 - 1516.
[Full Text]
[PDF]
|
|
|
|
|
|
|
The American Heart Association's Acute Myocardial, A. K. Jacobs, E. M. Antman, G. Ellrodt, D. P. Faxon, T. Gregory, G. A. Mensah, P. Moyer, J. Ornato, E. D. Peterson, et al.
Recommendation to Develop Strategies to Increase the Number of ST-Segment-Elevation Myocardial Infarction Patients With Timely Access to Primary Percutaneous Coronary Intervention
Circulation,
May 2, 2006;
113(17):
2152 - 2163.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
