title: Analysis of reperfusion time trends in patients with ST-elevation myocardial infarction across New York State from 2004 to 2012.
abstract: BACKGROUND
  Registry-driven data have shown a significant decrease in door-to-balloon (DTB) times in patients with ST-elevation myocardial infarction (STEMI) receiving percutaneous coronary intervention (PCI). We sought to determine the trends in reperfusion times (symptom-onset to door (SOTD) and DTB times) in patients presenting with STEMI across New York State.
  
  
  METHODS
  We retrospectively examined 35,613 STEMI patients receiving PCI from 2004 to 2012 and compared median SOTD and DTB times across years. Patients with SOTD time >12h and DTB time >3h were excluded.
  
  
  RESULTS
  There was a statistically significant trend towards shorter DTB times (median DTB time of 83min (IQR 53, 116) in 2004 to a median DTB time of 59min (IQR 40, 78) in 2012, P<0.01 for trend) and SOTD times (median SOTD time of 127min (IQR 64, 241) in 2004 to a median SOTD time of 116min (IQR 60, 205) in 2012, P<0.01 for trend). In subgroup analysis, demographics and the presence of co-morbid conditions did not influence the trend in reperfusion times. However, women had longer reperfusion times than men in 2012. After adjusting for confounding variables, DTB was a significant predictor of in-hospital mortality (HR=1.04 (per 10minutes), P<0.01).
  
  
  CONCLUSIONS
  There was a significant decrease in reperfusion times from 2004 to 2012 in STEMI patients across New York State. This trend was significant regardless of the presence of co-morbid conditions, although a significant gap in reperfusion times persists between men and women.
authors.affiliation: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States.
authors.forename: Subhi J
authors.initials: SJ
authors.lastname: Al'Aref
authors.affiliation: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States.
authors.forename: S Chiu
authors.initials: SC
authors.lastname: Wong
authors.affiliation: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States.
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Swaminathan
authors.affiliation: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States.
authors.forename: Patrick
authors.initials: P
authors.lastname: McNair
authors.affiliation: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States.
authors.forename: Dmitriy N
authors.initials: DN
authors.lastname: Feldman
authors.affiliation: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States.
authors.forename: Luke K
authors.initials: LK
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States.
authors.forename: Harsimran S
authors.initials: HS
authors.lastname: Singh
authors.affiliation: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Bergman
authors.affiliation: Division of Cardiology, Department of Medicine, NewYork Presbyterian Hospital - Weill Cornell Medical Center, New York, NY 10065, United States. Electronic address: rmm2002@med.cornell.edu.
authors.forename: Robert M
authors.initials: RM
authors.lastname: Minutello
mesh_terms: D005260:Female; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D061665:Time-to-Treatment / Q000639:trends*
keywords: Mortality; Myocardial infarction; Reperfusion times