ACUTE ST- ELEVATION MYOCARDIAL INFARCTION DOOR-TO-BALLOON TIME AND MORTALITY AMONG PATIENTS UNDERGOING PRIMARY PCI
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Abstract
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 1250 admissions for patients undergoing primary PCI for ST-segment elevation myocardial infarction from July 2020 through June 2021 at Cath PCI registrey of NICVD ( National Institute of Cardiovascular disease Karachi )
Methods: We analyzed annual trends in door-to-balloon times and in-hospital mortality using data from 1250 admissions for patients undergoing primary PCI for ST-segment elevation myocardial infarction from July 2020 through June 2021 . 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 2020 through June 2021 to 67 minutes in the 12 months 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 P=0.43 for trend) or in risk-adjusted in-hospital mortality , 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.
References
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Muhammad Irfan
Clinical Fellow NICVD Karachi, Pakistan
Muhammad Rafique Kanher
Assistant Professor, Adult / Interventional Cardiology, NICVD
Yusra
Consultant Cardiologist, Department of Cardiology, Liaquat University of Medical and Health Sciences Jamshoro, Pakistan.
Aadil Memon
Consultant / Senior Registrar NICVD Karachi, Pakistan
Salman Khan
Clinical Fellow NICVD Karachi, Pakistan.
Owais Khan
Postgraduate Resident Cardiology, Hayatabad Medical Complex Peshawar, Pakistan