• Jonghanne Park, Ki Hong Choi, Joo Myung Lee, Hyun Kuk Kim, Doyeon Hwang, Tae-Min Rhee, Jihoon Kim, Taek Kyu Park, Jeong Hoon Yang, Young Bin Song, Jin-Ho Choi, Joo-Yong Hahn, Seung-Hyuk Choi, Bon-Kwon Koo, Shung Chull Chae, Myeong Chan Cho, Chong Jin Kim, Ju Han Kim, Myung Ho Jeong, Hyeon-Cheol Gwon, Hyo-Soo Kim, and KAMIR‐NIH (Korea Acute Myocardial Infarction Registry–National Institutes of Health) Investigators.
• 1 Department of Internal Medicine and Cardiovascular Center Seoul National University Hospital Seoul Korea.
• J Am Heart Assoc. 2019 May 7; 8 (9): e012188.

AbstractBackground In patients with ST-segment-elevation myocardial infarction, timely reperfusion therapy with door-to-balloon (D2B) time <90 minutes is recommended by the current guidelines. However, whether further shortening of symptom onset-to-door (O2D) time or D2B time would enhance survival of patients with ST-segment-elevation myocardial infarction remains unclear. Therefore, the current study aimed to evaluate the prognostic impact of O2D or D2B time in patients with ST-segment-elevation myocardial infarction who underwent primary percutaneous coronary intervention. Methods and Results We analyzed 5243 patients with ST-segment-elevation myocardial infarction were treated at 20 tertiary hospitals capable of primary percutaneous coronary intervention in Korea. The association between O2D or D2B time with all-cause mortality at 1 year was evaluated. The median O2D time was 2.0 hours, and the median D2B time was 59 minutes. A total of 92.2% of the total population showed D2B time ≤90 minutes. In univariable analysis, 1-hour delay of D2B time was associated with a 55% increased 1-year mortality, whereas 1-hour delay of O2D time was associated with a 4% increased 1-year mortality. In multivariable analysis, D2B time showed an independent association with mortality (adjusted hazard ratio, 1.90; 95% CI , 1.51-2.39; P<0.001). Reducing D2B time within 45 minutes showed further decreased risk of mortality compared with D2B time >90 minutes (adjusted hazard ratio, 0.30; 95% CI , 0.19-0.42; P<0.001). Every reduction of D2B time by 30 minutes showed continuous reduction of 1-year mortality (90 to 60 minutes: absolute risk reduction, 2.4%; number needed to treat, 41.9; 60 to 30 minutes: absolute risk reduction, 2.0%; number needed to treat, 49.2). Conclusions Shortening D2B time was significantly associated with survival benefit, and the survival benefit of shortening D2B time was consistently observed, even <60 to 90 minutes.

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