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Study calls for 'as soon as possible' treatment standard for heart attack patients
May 20, 2009Research: Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: National cohort study, BMJ online
Once in hospital, heart attack patients should be treated without delay to cut their risk of death, ideally within even less than the 90 minutes currently recommended by clinical guidelines, say researchers in a paper published on bmj.com today.
After a heart attack, patients often undergo a procedure using a balloon-tipped catheter that is inserted into a main artery, pushed into the narrowed coronary artery, and inflated to clear the blockage. This is called primary percutaneous coronary intervention, or more simply balloon angioplasty.
The time between a patient's arrival at hospital and first balloon inflation is known as the "door-to-balloon time." The current target is 90 minutes, but the benefits of reducing this time even further is still unclear.
So researchers based in the United States set out to investigate the association between door-to-balloon time and deaths in hospital among patients undergoing balloon angioplasty after a heart attack.
They analysed data for 43,801 patients from the American College of Cardiology National Cardiovascular Data Registry. All patients underwent balloon angioplasty within 12 hours of a heart attack at a United States acute care hospital between 2005 and 2006.
Average door-to-balloon time was 83 minutes, with over half of patients (58%) treated within 90 minutes of admission. Overall in-hospital mortality was 4.6%. A greater proportion of patients who had longer door-to-balloon times were women, non-white, and, on average, older than patients with shorter door-to-balloon times. They also had more comorbidities (other disorders, such as diabetes and high blood pressure) than patients with shorter door-to-balloon times.
After adjusting for factors that may have affected the results, longer door-to-balloon times were associated with a higher risk of in-hospital mortality. For example, 3% of patients with door-to-balloon times of 30 minutes died in hospital, while 4.3% of patients with door-to-balloon times of 90 minutes died. The highest mortality rate (10.3%) was for patients with door-to-balloon times of 270 minutes.
These results indicate that any delay in door-to-balloon time for heart attack patients undergoing balloon angioplasty is associated with higher mortality, even among patients treated within 90 minutes of admission, say the authors.
"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. Such an approach, using necessary safeguards against inappropriate treatment, offers the potential for notable mortality reduction," they conclude.
BMJ-British Medical Journal
The time between a patient's arrival at hospital and first balloon inflation is known as the "door-to-balloon time." The current target is 90 minutes, but the benefits of reducing this time even further is still unclear.
So researchers based in the United States set out to investigate the association between door-to-balloon time and deaths in hospital among patients undergoing balloon angioplasty after a heart attack.
They analysed data for 43,801 patients from the American College of Cardiology National Cardiovascular Data Registry. All patients underwent balloon angioplasty within 12 hours of a heart attack at a United States acute care hospital between 2005 and 2006.
Average door-to-balloon time was 83 minutes, with over half of patients (58%) treated within 90 minutes of admission. Overall in-hospital mortality was 4.6%. A greater proportion of patients who had longer door-to-balloon times were women, non-white, and, on average, older than patients with shorter door-to-balloon times. They also had more comorbidities (other disorders, such as diabetes and high blood pressure) than patients with shorter door-to-balloon times.
After adjusting for factors that may have affected the results, longer door-to-balloon times were associated with a higher risk of in-hospital mortality. For example, 3% of patients with door-to-balloon times of 30 minutes died in hospital, while 4.3% of patients with door-to-balloon times of 90 minutes died. The highest mortality rate (10.3%) was for patients with door-to-balloon times of 270 minutes.
These results indicate that any delay in door-to-balloon time for heart attack patients undergoing balloon angioplasty is associated with higher mortality, even among patients treated within 90 minutes of admission, say the authors.
"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. Such an approach, using necessary safeguards against inappropriate treatment, offers the potential for notable mortality reduction," they conclude.
BMJ-British Medical Journal
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Common Pain Relievers May Dilute Power of Flu Shots
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A decade later, lifestyle changes or metformin still lower type 2 diabetes risk
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Research: Migraine and cardiovascular disease: Systematic review and meta-analysis
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UT Southwestern patient first in North Texas to receive newest-generation heart failure device
UT Southwestern Medical Center patient Michael LeBlanc, 40, is the first in North Texas to receive the newest generation of a mechanical device designed to improve heart function. It will be his lifeline while he awaits a heart transplant.
South Asian Canadians failing to get exercise message
Exercise is a wonderful way of boosting heart health, but it's proving to be a tough sell in Ontario South Asian communities, Dr. Milan Gupta told the Canadian Cardiovascular Congress 2009, co-hosted by the Heart and Stroke Foundation and the Canadian Cardiovascular Society.
The heart attack myth: Study establishes that women do have same the heart attack symptoms as men
The gender difference between men and women is a lot smaller than we've been led to believe when it comes to heart attack symptoms.
Angina in the legs? Time to alert patients and physicians
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