Foo CY, et al. - The link between door-to-balloon delay in primary percutaneous coronary intervention and ST-elevation myocardial infarction (MI) outcomes was investigated, along with potential effect modifiers. Longer door-to-balloon delay in primary percutaneous coronary intervention for ST-elevation MI was found to be associated with higher risk of adverse outcomes. This effect was modified by prehospital delays. Although door-to-balloon time in the U.S. has improved, the lack of population effect might be explained by the non-linearity of the time–risk relation.

Methods

• In this systematic review and meta-analysis, researchers analyzed data from prospective observational studies that investigated the relationship of door-to-balloon delay and clinical outcomes.
• Mortality and heart failure were main outcomes.

Results

• Adequate data for quantitative reporting was availed from 32 studies involving 299,320 patients.
• A higher risk of short-term mortality (pooled OR 1.52, 95% CI 1.40 to 1.65) and medium-term to long-term mortality (pooled OR 1.53, 95% CI 1.13 to 2.06) was observed in patients with ST-elevation MI who experienced longer (>90 min) door-to-balloon delay.
• Researchers noted a non-linear time–risk relation (P=0.004 for non-linearity).
• Between those who presented early and late after symptom onset, a difference was seen in the link between longer door-to-balloon delay and short-term mortality (Cochran’s Q 3.88, P value 0.049) with a stronger association among those with shorter prehospital delays.