title: Age-dependent impact of new ESC-Guideline recommended door-to-balloon times on mid-term survival in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  To investigate the age-dependent impact of the superfast door-to-balloon (D2B) times of ≤60min as recommended by the new ESC Guideline for patients with ST elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) on mid-term survival rates based on a single center registry dataset.
  
  
  METHODS
  This study enrolled consecutive STEMI patients who underwent PPCI from Jan 1, 2009 through Sep 30, 2013. We compared demographics, clinical characteristics and the D2B-survival relationships between patients aged ≥65 and <65.
  
  
  RESULTS
  The younger group comprised 242 patients (68%) aged <65 and the elder group consisted of 115 patients (32%) aged ≥65. In patients aged <65, the mortality rate decreased linearly with D2B time shortening (>90min vs. 61-90min vs. ≤60min=14.9% vs. 13.3% vs. 1.2%, P=0.001). Contrarily, shortening of D2B time was not associated with reduced mortality rate in patients aged ≥65 (>90min vs. 61-90min vs. ≤60min=23.5% vs. 19% vs. 18.9%, P=0.99). In younger patients but not the elderly, a D2B time of <60min has sufficient power to predict mortality with a sensitivity of 0.83, specificity of 0.74, and Youden index of 0.57.
  
  
  CONCLUSIONS
  Our results show that the new ESC Guideline recommendation of D2B time ≤60min is associated with better survival rates in younger STEMI patients undergoing PPCI. Our findings stress the importance of guideline adherence to minimize reperfusion delay to improve survival in these patients.
authors: Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40402, Taiwan; Division of Cardiovascular Medicine, China Medical University Hospital, Taichung 40447, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital; Division of Cardiovascular Medicine, Asia University Hospital, Taichung 41354, Taiwan.
authors: Yu-Chen
authors: YC
authors: Wang
authors: Division of Cardiovascular Medicine, China Medical University Hospital, Taichung 40447, Taiwan.
authors: Ying-Ying
authors: YY
authors: Huang
authors: Division of Cardiovascular Medicine, China Medical University Hospital, Taichung 40447, Taiwan.
authors: Ping-Hang
authors: PH
authors: Lo
authors: Graduate Institute of Clinical Medical Science, China Medical University, Taichung 40402, Taiwan; Division of Cardiovascular Medicine, China Medical University Hospital, Taichung 40447, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital. Electronic address: kuancheng.chang@gmail.com.
authors: Kuan-Cheng
authors: KC
authors: Chang
authors: Lipid Science and Aging Research Center, Kaohsiung Medical University, Kaohsiung 80780, Taiwan; Center for Lipid Biosciences, Kaohsiung Medical University Hospital, Kaohsiung 80780, Taiwan; Vascular and Medicinal Research, Texas Heart Institute, Houston 77030, TX, USA.
authors: Chu-Huang
authors: CH
authors: Chen
authors: Division of Cardiovascular Medicine, China Medical University Hospital, Taichung 40447, Taiwan; Cardiovascular Research Laboratory, China Medical University Hospital.
authors: Ming-Fong
authors: MF
authors: Chen
mesh_terms: D000367:Age Factors; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000401:mortality / Q000592:standards; D017410:Practice Guidelines as Topic / Q000592:standards*; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D061665:Time-to-Treatment / Q000592:standards*
keywords: Acute myocardial infarction; Percutaneous coronary intervention; Quality and outcomes of care