Association between door-to-balloon time ≤60 minutes and short- and long-term outcomes in patients with ST-segment elevation myocardial infarction: a retrospective cohort study
Zichen Wang, Zhaofeng Wang, Xuehan Zhi, Zhengsong Kang, Yunqing Liu, Kai Xu, Chengfei Peng, Yang Li, Haiwei Liu, Yaling HanBackground
Current guidelines diverge on the optimal door-to-balloon time (DTBT) for acute ST-segment elevation myocardial infarction (STEMI), and whether a ≤60 min target benefits all patients equally remains unclear.
Objectives
This study aimed to investigate whether the association between DTBT ≤60 min and short- and long-term prognosis in STEMI patients varies by Global Registry of Acute Coronary Events (GRACE) risk score.
Design
Retrospective cohort study.
Setting
Single high-volume tertiary cardiology centre in China.
Participants
This study initially included 5516 STEMI patients undergoing primary percutaneous coronary intervention (PPCI) treatment. 4513 were included after applying inclusion criteria (age >18 years, presentation within 12 hours of symptom onset, complete medical records) and exclusion criteria (symptom duration ≥12 hours, failure to receive PPCI, incomplete outcome data).
Interventions
Not applicable (observational study).
Primary and secondary outcome measures
The primary outcomes were in-hospital, 1-year and 3-year all-cause mortality. Secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE) at 1 and 3 years post-discharge.
Results
Among 4513 STEMI patients, 2433 (54.0%) were high-risk (HR-STEMI) and 2080 (46.0%) low-risk (LR-STEMI). DTBT ≤60 min was achieved in 45.7% of HR-STEMI and 52.0% of LR-STEMI patients. For HR-STEMI patients, DTBT >60 min was associated with significantly higher risks of in-hospital mortality (OR=2.381, 95% CI 1.160 to 4.883, p=0.018), 1-year mortality (HR=1.715, 95% CI 1.194 to 2.464, p=0.003), 1-year MACCE (HR=1.212, 95% CI 1.001 to 1.467, p=0.049), 3-year mortality (HR=1.689, 95% CI 1.267 to 2.253, p<0.001), and 3-year MACCE (HR=1.230, 95% CI 1.042 to 1.453, p=0.014). Among LR-STEMI patients, no significant differences were observed between DTBT groups.
Conclusions
DTBT ≤60 min was significantly associated with better short- and long-term outcomes, particularly in patients with GRACE >140. Sensitivity analysis suggested that the benefit may also extend to patients with GRACE scores between 120 and 140.
Trial registration number
Not applicable (observational study).