Door-to-Balloon Times Have Improved in Primary PCI
From 2005 to 2009, door-to-balloon times improved, but no change in in-hospital mortality
WEDNESDAY, Sept. 4 (HealthDay News) -- For patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI), despite improvement in door-to-balloon times there has been no change in in-hospital mortality, according to a study published in the Sept. 5 issue of the New England Journal of Medicine.
Daniel S. Menees, M.D., from the University of Michigan in Ann Arbor, and colleagues examined annual trends in door-to-balloon times and in-hospital mortality using data from 96,738 admissions for patients with ST-segment elevation myocardial infarction undergoing primary PCI from July 2005 to June 2009. Thirty-day mortality was assessed in subgroup analysis using a linked Medicare data set.
The researchers found that, from July 2005 through June 2006 to July 2008 through June 2009, the median door-to-balloon times decreased significantly from 83 to 67 minutes. During the same time period there was a significant increase in the percentage of patients for whom door-to-balloon time was 90 minutes or less, from 59.7 to 83.1 percent. There was no significant change seen in unadjusted in-hospital mortality (4.8 to 4.7 percent; P = 0.43 for trend), risk-adjusted in-hospital mortality (5.0 to 4.7 percent; P = 0.34), or in unadjusted 30-day mortality (P = 0.64)
"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," the authors write. "These data suggest that additional strategies are needed to reduce in-hospital mortality in this population."
Several authors disclosed financial ties to the pharmaceutical and health care insurance industries; one author reported serving as an expert witness.