Door-to-balloon time and mortality among patients undergoing primary PCI

摘要

Background Current guidelines for the treatment of ST-segment elevation myocardial infarction recommend a door-to-balloon time of 90 minutes or less for patients undergoing primary percutaneous coronary intervention(PCI).Door-to-balloon time has become a performance measure and is the focus of regional and national quality-improvement initiatives.However,it is not known whether national improvements in door-to-balloon times have been accompanied by a decline in mortality.Methods We analyzed annual trends in door-to-balloon times and in-hospital mortality using data from 96,738 admissions for patients undergoingprimary PCI for ST-segment elevation myocardial infarction from July 2005through June 2009 at 515 hospitals participating in the CathPCI Registry.In a subgroup analysis using a linked Medicare data set,we assessed 30-day mortality.Results Median door-to-balloon times declined significantly,from 83 minutes in the 12 months from July 2005through June 2006 to 67 minutes in the 12 months from July 2008 through June 2009(P<0.001).Similarly,the percentage of patients for whom the door-to-balloon time was 90 minutes or less increased from 59.7%in the first year to 83.1%in the last year(P<0.001).Despite improvements in door-to-balloon times,there was no significant overall change in unadjusted in-hospital mortality(4.8%in 2005-2006 and 4.7%in 2008-2009,P=0.43 for trend)or in risk-adjusted in-hospital mortality(5.0%in 2005-2006 and 4.7%in 2008-2009,P=0.34),nor was a significant difference observed in unadjusted 30-day mortality(P=0.64).Conclusions Although national door-to-balloon times have improved significantly for patients undergoing primary PCI for ST-segment elevation myocardial infarction,in-hospital mortality has remained virtually unchanged.These data suggest that additional strategies are needed to reduce in-hospital mortality in this population.