Prior Heart Surgery Linked to Longer Door-to-Balloon Time

But does not affect risk of in-hospital mortality

TUESDAY, Nov. 4 (HealthDay News) -- Patients undergoing primary percutaneous coronary intervention for a heart attack have longer door-to-balloon times (time between medical contact and first intracoronary balloon inflation) but no higher risk of in-hospital mortality if they have a history of coronary artery bypass grafting (CABG) surgery, according to a report in the Nov. 11 issue of the Journal of the American College of Cardiology.

Michael S. Kim, M.D., from the University of Colorado Denver in Aurora, and colleagues examined whether a history of CABG surgery was associated with longer door-to-balloon times in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention. The study compared 4,211 patients with previous CABG and 69,001 patients without previous CABG.

The researchers found that median door-to-balloon time was significantly longer in patients with previous CABG (113 versus 98 minutes), and significantly more patients with previous CABG had a door-to-balloon time greater than the recommended 90 minutes (68.4 versus 56.7 percent). Of the 3,623 patients (5.2 percent) who died in the hospital, CABG surgery was associated with a significantly higher risk of in-hospital mortality, although this was no longer significant after adjusting for baseline patient characteristics (odds ratio 1.07) and the increased door-to-balloon time (odds ratio 1.04), the report indicates.

"Previous CABG surgery was associated with a significantly longer median door-to-balloon time in patients undergoing primary percutaneous coronary intervention for STEMI compared with patients without a history of CABG surgery," Kim and colleagues conclude. "This finding did not translate into a greater in-hospital risk-adjusted mortality, yet it may substantially impact the performance measurement for a given hospital depending on the case mix."

Full Text (subscription or payment may be required)

Physician's Briefing