Prognostic Implications of Door‐to‐Balloon Time and Onset‐to‐Door Time on Mortality in Patients With ST‐Segment–Elevation Myocardial Infarction Treated With Primary Percutaneous Coronary Intervention

Abstract

Background In patients with ST‐segment–elevation myocardial infarction, timely reperfusion therapy with door‐to‐balloon (D2B) time <90 minutes is recommended by the current guidelines. However, whether further shortening of symptom onset‐to‐door (O2D) time or D2B time would enhance survival of patients with ST‐segment–elevation myocardial infarction remains unclear. Therefore, the current study aimed to evaluate the prognostic impact of O2D or D2B time in patients with ST‐segment–elevation myocardial infarction who underwent primary percutaneous coronary intervention. Methods and Results We analyzed 5243 patients with ST‐segment–elevation myocardial infarction were treated at 20 tertiary hospitals capable of primary percutaneous coronary intervention in Korea. The association between O2D or D2B time with all‐cause mortality at 1 year was evaluated. The median O2D time was 2.0 hours, and the median D2B time was 59 minutes. A total of 92.2% of the total population showed D2B time ≤90 minutes. In univariable analysis, 1‐hour delay of D2B time was associated with a 55% increased 1‐year mortality, whereas 1‐hour delay of O2D time was associated with a 4% increased 1‐year mortality. In multivariable analysis, D2B time showed an independent association with mortality (adjusted hazard ratio, 1.90; 95% CI , 1.51–2.39; P <0.001). Reducing D2B time within 45 minutes showed further decreased risk of mortality compared with D2B time >90 minutes (adjusted hazard ratio, 0.30; 95% CI , 0.19–0.42; P <0.001). Every reduction of D2B time by 30 minutes showed continuous reduction of 1‐year mortality (90 to 60 minutes: absolute risk reduction, 2.4%; number needed to treat, 41.9; 60 to 30 minutes: absolute risk reduction, 2.0%; number needed to treat, 49.2). Conclusions Shortening D2B time was significantly associated with survival benefit, and the survival benefit of shortening D2B time was consistently observed, even <60 to 90 minutes.

Impact of the COVID-19 Pandemic on Door-to-Balloon Time for Primary Percutaneous Coronary Intervention ― Results From the Singapore Western STEMI Network ―

“…The recipient hospital's D2B time was defined as the time taken from the patient's arrival at the receiving hospital to the time of first device deployment, defined as balloon inflation, manual thrombectomy or direct stenting, during PCI. 4 The first D2B time (Dto1B) was defined as time of arrival at the referring hospital to the time of first device deployment at the receiving hospital. 17 D1toB was further categorized according to the following time intervals: the door-in to door-out (DIDO) time was defined as the time from arrival to discharge at the referring hospital, ambulance transport time from referring to receiving hospital (D1toD2), and the time from arrival at receiving hospital to first device deployment during PCI (D2toB).…”

COVID-19 Pandemic: Cardiovascular Complications and Future Implications

“…When put in the context of existing data on door-to-balloon (D2B) time and CV outcomes, while 60-90 min estimates the absolute risk reduction of 1-year mortality at 2.4%, the odds worsen when this time increases to 90-120 min. In the same study, an incremental increase in the D2B time by 1 h was associated with a 64% increase in 1-year mortality (HR 1.90, 95% CI 1.51-2.39; p < 0.001) [60].…”

Treatment of Patients with Acute Coronary Syndrome with ST Segment Elevation in Clinical Practice of the Republic of Karelia: the Results of 10-year Register

“…Хорошо известно, что сроки проведения ТЛТ и ЧКВ определяют объем спасенного миокарда и коррелируют с прогнозом у пациентов, переносящих ОИМ [6,8]. В поздние сроки от развития ОИМ эффективность реперфузионных вмешательств значительно снижается [20], при этом возрастает риск развития осложнений, в первую очередь -нарушений ритма, разрывов миокарда и геморрагических событий [13,21]. С учетом этого выполнение ТЛТ не рекомендовано позднее 12 ч от начала клинической симпто-матики, а ЧКВ нецелесообразно в течение 48 ч от развития ОИМпST [6,11,21].…”

“…В поздние сроки от развития ОИМ эффективность реперфузионных вмешательств значительно снижается [20], при этом возрастает риск развития осложнений, в первую очередь -нарушений ритма, разрывов миокарда и геморрагических событий [13,21]. С учетом этого выполнение ТЛТ не рекомендовано позднее 12 ч от начала клинической симпто-матики, а ЧКВ нецелесообразно в течение 48 ч от развития ОИМпST [6,11,21]. В то же время консервативное ведение пациентов с ОИМ сопряжено с повышенным риском развития осложнений, в том числе, фатальных, в остром периоде, а также ассоциировано с развитием серьезных отдаленных последствий ОКС [16][17][18][19].…”