title: Reperfusion times and in-hospital outcomes among patients with an isolated posterior myocardial infarction: insights from the National Cardiovascular Data Registry (NCDR).
abstract: BACKGROUND
  A posterior myocardial infarction (PMI) is associated with significant morbidity and delays in recognition may prevent the timely revascularization of these patients. The present study sought to evaluate the reperfusion times and in-hospital outcomes among patients with an isolated PMI.
  
  
  METHODS
  Clinical characteristics and reperfusion times were compared between those with an isolated PMI and those with all other ST-elevation myocardial infarctions (STEMI) in the NCDR ACTION-GWTG Registry from 2007 to 2012. Logistic generalized estimating equations were used to examine risk-adjusted mortality.
  
  
  RESULTS
  Among 117,739 subjects with a STEMI, 824 (0.7%) had evidence of an isolated PMI. The median time between patient arrival and initial electrocardiogram was similar between those with an isolated PMI and those with a non-PMI STEMI (6 vs. 6 minutes, P = .48). However, the median time from initial electrocardiogram to percutaneous coronary intervention was significantly longer among subjects with a PMI (69 vs 61 minutes, P < .01) and fewer patients achieved a door-to-balloon time less than 90 minutes (83% vs 89%, P < .01). After multivariable adjustment, in-hospital mortality was similar for PMI patients compared to those with a non-PMI STEMI (AOR: 1.11, 95% CI: 0.83-1.50).
  
  
  CONCLUSIONS
  The door-to-balloon times are significantly longer for those with an isolated PMI resulting in fewer patients receiving reperfusion within the guideline recommended time period. Ongoing educational initiatives to increase recognition of a PMI are needed to improve the reperfusion times and outcomes associated with this condition.
authors.affiliation: Department of Medicine, Division of Cardiology, Massachusetts General Hospital, Boston, MA. Electronic address: swaldo@partners.org.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Waldo
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Brenner
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Shuang
authors.initials: S
authors.lastname: Li
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, NC.
authors.forename: Karen
authors.initials: K
authors.lastname: Alexander
authors.affiliation: Department of Medicine, University of California, San Francisco, CA; Division of Cardiology, San Francisco General Hospital, San Francisco, CA.
authors.forename: Peter
authors.initials: P
authors.lastname: Ganz
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000706:statistics & numerical data*; D012042:Registries; D013997:Time Factors; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D016896:Treatment Outcome