• Rajendra H Mehta, Vincent J Bufalino, Wenqin Pan, Adrian F Hernandez, Christopher P Cannon, Gregg C Fonarow, Eric D Peterson, and American Heart Association Get With the Guidelines Investigators.
• Duke Clinical Research Institute and Duke University Medical Center, Durham, NC, USA.
• Am. Heart J. 2008 Jun 1; 155 (6): 1059-67.

BackgroundThe speed of reperfusion (door-to-balloon [D2B] time) is a well established performance metric for patients with ST-elevation myocardial infarction. Although preferably D2B times should be MethodsWe used the American Heart Association Get With the Guidelines database to study D2B times at 254 participating United States sites (2002-2006). Median D2B time and percentage of compliance with goal (percutaneous coronary interventions [PCI] ResultsOver the study period, 10965 patients with ST-elevation myocardial infarction who met eligibility criteria received primary PCI (36% aged >or=65 years, 27% female, and 17% nonwhite). The overall median D2B time was 96 minutes (interquartile range [IQR] 69-140 minutes). Only 44.8% of cases had D2B or=65 years (103 [IQR 74-153] vs 93 [IQR 67-133] minutes), women (103 [IQR 73-154] vs 94 [IQR 68-135] minutes), and minorities (108 [IQR 77-162] vs 95 [IQR 68-136] minutes) had significantly longer median D2B times. These subgroup disparities in the D2B persisted over the study period as compared with their peers.ConclusionThe median D2B times with primary PCI have improved modestly in hospitals participating in the American Heart Association Get With the Guidelines program over the last few years but remain below ideal levels. The D2B times are particularly delayed in the elderly people, women, and minority populations; an issue that has persisted over time. These results highlight the ongoing need for national myocardial infarction quality improvement initiatives.

18 keywords...

hide…