Shorter Door-In to Door-Out Time Tied to Better Outcomes
Patients transferred for reperfusion in 30 minutes or less have lower in-hospital mortality
WEDNESDAY, June 22 (HealthDay News) -- A door-in to door-out (DIDO) time of 30 minutes or less for patients with ST-elevation myocardial infarction (STEMI), transferred for primary percutaneous coronary intervention (PCI) is associated with shorter reperfusion delays and reduced in-hospital mortality, according to a study published online June 22/29 in the Journal of the American Medical Association.
Tracy Y. Wang, M.D., M.H.S., from the Duke University Medical Center in Durham, N.C., and colleagues investigated the time to reperfusion and patient outcomes associated with a DIDO time of 30 minutes or less in 14,821 patients with STEMI, who were transferred for primary PCI. The main outcomes studied included variables associated with a DIDO time longer than 30 minutes, overall door-to-balloon (DTB) times, and risk-adjusted in-hospital mortality.
The investigators found that the median DIDO time was 68 minutes; and DIDO times of 30 minutes or less were seen in 1,627 patients (11 percent). Significant factors correlated with a longer DIDO time (>30 minutes) included older age, being female, presenting during off-hours, and non-emergency transport to the initial hospital. Patients with a DIDO time of 30 minutes or less had a significantly higher likelihood of having an overall DTB time of 90 minutes or less compared to those with a DIDO time above 30 minutes (60 versus 13 percent). In-hospital mortality was significantly higher among patients with DIDO times above 30 minutes compared to those with DIDO times of 30 minutes or less (adjusted odds ratio, 1.56).
"A DIDO time of 30 minutes or less was observed in only a small proportion of patients transferred for primary PCI, but was associated with shorter reperfusion delays and lower in-hospital mortality," the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.