Volume 104, Issue 9 , Pages 1198-1203, 1 November 2009
Association of Door-to-Balloon Time and Mortality in Patients ≥65 Years With ST-Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Current guidelines recommend patients with ST-elevation myocardial infarction receive primary percutaneous coronary intervention (PCI) within 90 minutes of admission, although there are conflicting data regarding the relation between time to treatment and mortality in these patients. We used logistic regression analyses employing a fractional polynomial model to evaluate the association between door-to-balloon time and 1-year mortality in patients with ST-elevation myocardial infarction ≥65 years old undergoing primary PCI from 1994 to 1996 (n = 1,932). Median door-to-balloon time was 128 minutes (interquartile range 92 to 178, 24.2% treated within 90 minutes). Overall 1-year mortality was 21.1%. Longer door-to-balloon times were associated with higher 1-year mortality in a continuous, nonlinear fashion (30 minutes 10.9%, 60 minutes 13.6%, 90 minutes 16.5%, 120 minutes 19.5%, 150 minutes 22.5%, 180 minutes 25.3%, 210 minutes 27.9%). The nature of the association between door-to-balloon time and 1-year mortality was best modeled by a second-degree fractional polynomial (p <0.001). Findings were similar after multivariable adjustment as any increase in door-to-balloon time was associated with successive increases in patients' 1-year mortality (30 minutes 8.8%, 60 minutes 12.9%, 90 minutes 16.6%, 120 minutes 19.9%, 150 minutes 22.9%, 180 minutes 25.5%, 210 minutes 27.7%). In conclusion, any delay in primary PCI is associated with increased 1-year mortality, suggesting efforts should focus on decreasing time to treatment as much as possible, even among those centers currently providing primary PCI within 90 minutes.
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Mr. Rathore is supported by Medical Scientist Training Grant GM07205 from the National Institutes of Health, Bethesda, Maryland. Dr. Nallamothu is supported as a clinical scholar under K12 Grant RR017607-01 from the National Institutes of Health. Dr. Foody is supported by Research Career Award K08-AG20623-01 from the National Institute on Aging, Bethesda, Maryland, and a National Institute on Aging/Hartford Foundation Fellowship in Geriatrics, Bethesda, Maryland. Dr. Masoudi is supported by Research Career Award K08-AG01011 from the National Institute on Aging. This research was supported by Grant R01 HL072575 from the National Heart, Lung and Blood Institute, Bethesda, Maryland. The analyses on which this publication is based were performed under Contract 500-02-CO-01, entitled “Utilization and Quality Control Peer Review Organization for the State of Colorado,” sponsored by the Centers for Medicare and Medicaid Services (formerly Health Care Financing Administration), US Department of Health and Human Services, Baltimore, Maryland. The content of this publication does not necessarily reflect the views or policies of the U.S. Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. This publication is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care, and therefore required no special funding on the part of this Contractor. Ideas and contributions to the author concerning experience in engaging with issues presented are welcomed.
PII: S0002-9149(09)01260-0
doi:10.1016/j.amjcard.2009.06.034
© 2009 Elsevier Inc. All rights reserved.
Volume 104, Issue 9 , Pages 1198-1203, 1 November 2009
