Door-to-angioplasty recommendation: the sooner, the better, study finds

Current quality improvement initiatives, such as the Door-to-Balloon Alliance, have been established to achieve a "hospital-door-to-angioplasty-time" of 90 minutes or less. Several hospitals have been able to successfully push beyond this benchmark and have achieved median door-to-balloon times close to 60 minutes. However, little data has existed  on whether there are incremental benefits by achieving further reductions beyond 90 minutes - until now.

The Yale University School of Medicine conducted a study to evaluate the association between door-to-balloon time and mortality in hospital in patients undergoing angioplasty, a procedure in which a catheter with a balloon is inserted into the main artery and inflated to clear the blockage. The researchers reviewed data on 43,801 acute care patients who had been hospitalized in the United States from 2005 to 2006. All of the patients had undergone angioplasty within 12 hours of having a heart attack. As the time from "hospital door to angioplasty" increased, mortality rates increased:  from 3 percent of patients dying within 30 minutes of undergoing the procedure to 4.3 percent within 90 minutes to 10.3 percent for patients with door-to-balloon time of 4 hours and 30 minutes.

The study, which was led by Saif Rathore of the Yale University School of Medicine, suggests that the new guideline for undergoing percutaenous coronary interventions - aka angioplasties - after heart attack should be "the sooner, the better." "Rather than accepting the 90 minute door-to-balloon time benchmark, our data support calls for an 'as soon as possible' standard for patients undergoing primary percutaneous coronary intervention," says the study authors, who in conclusion wrote: "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 centers currently providing primary percutaneous coronary intervention within 90 minutes."

News Release: Cutting angioplasty time increases odds  www.upi.com May 21, 2009

Study abstract: Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study http://www.bmj.com/cgi/content/full/338/may19_1/b1807 May 19, 2009

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