Effect of onset-to-door time and door-to-balloon time on mortality in patients undergoing percutaneous coronary interventions for ST-segment elevation myocardial infarction

It is important to identify the factors related to survival of patients undergoing primary percutaneous coronary intervention for ST-segment elevation acute myocardial infarction. Our objective was to determine the interactive effect of the door-to-balloon (DTB) time and onset-to-door (OTD) time on longer term mortality for patients with ST-segment elevation acute myocardial infarction. The present study was a retrospective cohort analysis of the effect of the DTB time and OTD time on longer term (median follow-up 413 days) mortality for patients undergoing primary percutaneous coronary intervention in New York from January 1, 2004 to December 31, 2006, adjusting for the effect of other important risk factors. The patients with ST-segment elevation acute myocardial infarction with a DTB time of ≥90 minutes and OTD time of <4 hours had the lowest longer term mortality (3.51%). Patients with a DTB time ≥90 minutes and OTD time of ≥4 hours had significantly greater mortality than patients with an OTD time of <4 hours and DTB time of <90 minutes (adjusted hazard ratio 1.54, 95% confidence interval 1.04 to 2.30), as did patients with a DTB time of ≥90 minutes and OTD time of <4 hours (adjusted hazard ratio 1.48, 95% confidence interval 1.05 to 2.09). For an OTD time of <4 hours and DTB time of <90 minutes, mortality showed a trend toward being greater compared to shorter OTD and DTB times (adjusted hazard ratio 1.29, 95% confidence interval 0.95 to 1.77). In conclusion, the combination of short (<90 minutes) DTB time and short (<4 hours) OTD time was associated with the lowest longer term mortality rate.