June 21st, 2011

Study Finds Critical Delay in Most MI Patients Transferred for Primary PCI

MI patients who arrive at hospitals unable to perform primary PCI need to be promptly transferred to another hospital in order to receive the full benefits of reperfusion. Unfortunately, these patients often have prolonged door-to-balloon times. A key element in the delay is the time spent at the first hospital, referred to as the door-in to door-out (DIDO) time. A new study published in JAMA demonstrates that a DIDO time of 30 minutes or less is associated with shorter reperfusion delays and lower in-hospital mortality, but the study also shows that only a small proportion of patients are currently transferred this rapidly.

Using registry data on 14,821 patients with STEMI who were transferred to 298  hospitals for primary PCI, Wang and colleagues found that the median DIDO time was 68 minutes, and only 11% of patients had DIDO times within the recommended 30 minutes. The median door-to-balloon time was 85 minutes in those with a DIDO time of 30 minutes or less, compared with 127 minutes in those with longer DIDO times (P<0.001). Mortality was 2.7% in the 30-minutes-or-less group versus 5.9% in those with longer DIDO times (P<0.001). The mortality difference remained significant after adjusting for differences in baseline characteristics and presenting features between the groups.

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