title: Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study.
abstract: OBJECTIVE
  To evaluate the association between door-to-balloon time and mortality in hospital in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction to assess the incremental mortality benefit of reductions in door-to-balloon times of less than 90 minutes.
  
  
  METHODS
  Prospective cohort study of patients enrolled in the American College of Cardiology National Cardiovascular Data Registry, 2005-6.
  
  
  METHODS
  Acute care hospitals.
  
  
  METHODS
  43 801 patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.
  
  
  METHODS
  Mortality in hospital.
  
  
  RESULTS
  Median door-to-balloon time was 83 minutes (interquartile range 6-109, 57.9% treated within 90 minutes). Overall mortality in hospital was 4.6%. Multivariable logistic regression models with fractional polynomial models indicated that longer door-to-balloon times were associated with a higher adjusted risk of mortality in hospital in a continuous non-linear fashion (30 minutes=3.0%, 60 minutes=3.5%, 90 minutes=4.3%, 120 minutes=5.6%, 150 minutes=7.0%, 180 minutes=8.4%, P<0.001). A reduction in door-to-balloon time from 90 minutes to 60 minutes was associated with 0.8% lower mortality, and a reduction from 60 minutes to 30 minutes with a 0.5% lower mortality.
  
  
  CONCLUSIONS
  Any delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital in those admitted with ST elevation myocardial infarction. Time to treatment should be as short as possible, even in centres currently providing primary percutaneous coronary intervention within 90 minutes.
authors.affiliation: Yale University School of Medicine, 367 Cedar Street, 316 ESH, New Haven, Connecticut 06510, USA. saif.rathore@yale.edu
authors.forename: Saif S
authors.initials: SS
authors.lastname: Rathore
authors.forename: Jeptha P
authors.initials: JP
authors.lastname: Curtis
authors.forename: Jersey
authors.initials: J
authors.lastname: Chen
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.forename: Brahmajee K
authors.initials: BK
authors.lastname: Nallamothu
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Epstein
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon / Q000401:mortality*; D015331:Cohort Studies; D004638:Emergency Treatment / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D013997:Time Factors; D014187:Transportation of Patients; D014481:United States