Door-to-Balloon Time and Mortality

Jason, a reader, yesterday raised the following question about door to balloon times:

So I read something interesting a while back and unfortunately Iím not going to be able to site a source but it said this. A door to ballon time (d2b) of < 90 mins was immensely beneficial in decreasing m&m in STEMI pt's. We all know that now. It said a d2b < 75 mins added a little more benefit in reducing m&m. But I think at about d2b of about 60 mins we start to approach the limit. That is in decreasing d2b below 60 mins we realize no additional benefit.
Can anyone site the study?

There are many studies out there. Most of what I have read suggests the shorter the door-to-balloon time the better. Here is the study I use in some of my presentations.Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study. It was published in the British Medical Journal in 2009.

Here was the conclusion:

“Any delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital in those admitted with ST elevation myocardial infarction. Time to treatment should be as short as possible, even in centres currently providing primary percutaneous coronary intervention within 90 minutes.”

Here is a graph from that article illustrating the impact of decreasing door-to-balloon times on mortality.

A new study, also in the British Medical Journal (May 2012), Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study, suggests that what really matters is presentation to balloon time. And that in those patients who present early, the shortest possible door-to-balloon time improves outcomes.

Here is their summary:

What is already known on this topic:

Results from previous studies are quite inconsistent regarding the relation of symptom onset to balloon time and clinical outcomes in patients with ST segment elevation myocardial infarction.

The time to evaluate endpoints varied widely between these different studies.

Little is known about the relation of onset to balloon time with long term clinical outcomes in actual clinical practice.

What this study adds:

A clear association has been shown between a short onset to balloon time of less than three hours and better long term (three year) clinical outcomes.

The benefit of short door to balloon time was limited to patients who presented early.

Further improvement in the outcome of patients with ST segment elevation myocardial infarction could be achieved by reducing the total ischaemic time with various efforts.

The bottom line for paramedics is do everything we can to contribute to the safe shortening of door-to-balloon times in STEMI patients. The best way we can do that is through early activation.

2 Comments

  • Terry says:

    Today’s issue of the New England Journal posts an article stating that although DTB times have gone down significantly, patient mortality has not. Very Interesting.

    • medicscribe says:

      Interesting. Thanks, I will have to check it out.

      I won’t be able to access the full article until tomorrow, but looking at the site there is an accompanying perspective article that says the following:

      Time to Treatment in Patients with STEMI
      Eric R. Bates, M.D., and Alice K. Jacobs, M.D.
      N Engl J Med 2013; 369:889-892September 5, 2013DOI: 10.1056/NEJMp1308772

      Share:
      The focus on door-to-balloon time has expedited arrival in the cardiac catheterization laboratory for patients with ST-segment elevation myocardial infarction. Now the main opportunity for improving outcomes lies in the prehospital system of care, where challenges remain.

      I’ll post something on this after I have read it.

      Peter

1 Trackback

Leave a Reply

Your email address will not be published. Required fields are marked *

background image Blogger Img

Peter Canning

JEMS Talk: Google Hangout

Recent Posts
copy-medicscribeheader.png Intranasal Medication April 26, 2015
SW_Rectangle The Jug March 26, 2015
SW_Rectangle The Ideal Medic March 24, 2015
The Butler Did It February 19, 2015
Categories
  • ems-health-safety (7)
  • ems-topics (703)
  • hazmat (1)
  • Uncategorized (420)
  • Comments
    Steve
    Intranasal Medication
    "either because they are seizing or are violent, then the better and quicker route would be IM. " I'm quite hesitant about bring a needle against someone fighting me or shaking... those are the perfect times to be needleless.
    2015-04-27 18:34:14
    bill
    The Ideal Medic
    very well put! aggression can be a good in moderation but over aggression can do harm. 1 year to 30 years no medic will know it all epically with our ever changing job description. thank you for your input!
    2015-04-26 11:46:50
    Ben Leighton
    Adenosine
    Hi. Im a UK Student Paramedic and I have a few questions regarding adenosine (we currently dont carry it) and I was wondering if any of you guys could e-mail me at ben-leighton@hotmail.co.uk and start some correspondance. Im aiming to set a proposal to my service in order to carry this drug and wanted some…
    2015-04-20 13:36:03
    Ihunanya udochu
    AHA 2015 Guidelines: A Preview
    Airway protection is important in a cardiac arrest patient especially endotracheal intubation unlike supraglottic airway which does not and there is risk of aspiration.A paramedic should learn how to intubate the trachea, pass an LMA and NG tube. Protecting the airway shouldn't be enough, paramedics should know how to position his hands, and also the…
    2015-04-07 15:56:27
    medicscribe
    No Chest Compressions
    You can't do CPR without chest compressions. If you don't do chest compressions it is not CPR. The patient's heart has stopped. Aside from opening their chest and doing cardiac massage, there is no way to make the heart pump without doing chest compressions. Chest compressions are by nature traumatic. Ribs are often broken by…
    2015-04-01 21:24:02

    Now Available: Mortal Men

    Mortal Men is available as an electronic book for Kindle, Nook or any other e-reader. Here is a link to some of the places to buy it. The book sells for $3.99. Barnes and Noble Amazon Smashwords Scribd Also Available from iBooks

    Order My Books

    Support EMS Bloggers, Buy Their Books

    Google

    Order Books and Movies

    FireEMS Blogs eNewsletter

    Sign-up to receive our free monthly eNewsletter

    LATEST EMS NEWS

    HOT FORUM DISCUSSIONS