Hospital Admission Delay in Non-STEMI Unchanged
Another study finds dramatic door-to-balloon time reduction in STEMI but no mortality impact
TUESDAY, Nov. 9 (HealthDay News) -- Among patients with non-ST-segment elevation myocardial infarction (STEMI), the median delay time from symptom onset to hospital presentation is long and has not changed significantly, according to a study published in the Nov. 8 issue of the Archives of Internal Medicine. According to another study in the same issue, there has been a substantial reduction in median door-to-balloon (DTB) time in patients with STEMI, but this has not resulted in a change in in-hospital mortality.
In one study, Henry H. Ting, M.D., of the Mayo Clinic in Rochester, Minn., and colleagues evaluated 104,622 patients with non-STEMI enrolled at 568 hospitals between Jan. 1, 2001, and Dec. 31, 2006. The investigators found that the median delay time between symptom onset and hospital presentation was 2.6 hours and that it did not change significantly between 2001 and 2006. Patients who presented during weekend and weekday nights had 24.3 and 24.7 percent shorter delay times, respectively, than those who presented during weekday daytime.
In the other study, Anneliese Flynn, M.D., of the University of Michigan in Ann Arbor, and colleagues evaluated the yearly trend in DTB time for 8,771 patients with STEMI who underwent primary percutaneous coronary intervention (PCI) from 2003 to 2008. The investigators found a substantial reduction in median DTB time (from 113 to 76 minutes) and increased compliance with national guidelines (the percentage of patients revascularized with a DTB time of less than 90 minutes increased from 28.5 to 67.2 percent). However, in-hospital mortality remained unchanged between 2003 and 2008.
"Our results suggest that successful implementation of efforts to reduce DTB time has not translated into a reduction in in-hospital mortality. Further studies are warranted to identify strategies that could improve the outcome of patients undergoing primary PCI," Flynn and colleagues write.
The first study was funded by Bristol-Myers Squibb, Sanofi-Aventis, Schering-Plough, and Millennium Pharmaceuticals. Two authors disclosed financial ties to these and other pharmaceutical companies. The second study was funded by Blue Cross Blue Shield of Michigan, with three authors disclosing financial ties to the organization.