Conclusion: D2B time decreased over the course of the study

So, does lower D2B correlate with decreased mortality?

• Overall, unadjusted mortality if D2B less than or equal to 90 minutes: 4.8% in first year of study
• Overall, unadjusted mortality if D2B greater than 90 minutes: 4.7% in the last year of the study

When these were risk adjusted, there was no statistical difference in mortality

Conclusion: No difference in mortality despite improved D2B times

Take-hom e message

So despite reductions in D2B times across the nation, we have not impacted 30-day-in-hospital mortality. Maybe what we should be measuring is symptom onset to balloon time?

Dr. Salim Rezaie is a clinical assistant professor of EM and IM at the University of Texas Health Science Center at San Antonio.This blog first appeared in “Academic Life in Emergency Medicine.”

References

1. E.H. Bradley, J. Herrin, Y. Wang, B.A. Barton, T.R. Webster, J.A. Mattera, S.A. Roumanis, J.P. Curtis, B.K. Nallamothu, D.J. Magid, R.L. McNamara, J. Parkosewich, J.M. Loeb, and H.M. Krumholz, “Strategies for reducing the door-to-balloon time in acute myocardial infarction,” The New England Journal of Medicine, 2006. http://www.ncbi.nlm.nih.gov/pubmed/17101617
2. D.S. Menees, E.D. Peterson, Y. Wang, J.P. Curtis, J.C. Messenger, J.S. Rumsfeld, and H.S. Gurm, “Door-to-balloon time and mortality among patients undergoing primary PCI.”, The New England Journal of Medicine, 2013. http://www.ncbi.nlm.nih.gov/pubmed/24004117