Clinical Research
Acute Coronary Syndromes
Nonsystem Reasons for Delay in Door-to-Balloon Time and Associated In-Hospital Mortality: A Report From the National Cardiovascular Data Registry

https://doi.org/10.1016/j.jacc.2012.11.073Get rights and content
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Objectives

The goal of this study was to characterize nonsystem reasons for delay in door-to-balloon time (D2BT) and the impact on in-hospital mortality.

Background

Studies have evaluated predictors of delay in D2BT, highlighting system-related issues and patient demographic characteristics. Limited data exist, however, for nonsystem reasons for delay in D2BT.

Methods

We analyzed nonsystem reasons for delay in D2BT among 82,678 ST-segment elevation myocardial infarction patients who underwent primary percutaneous coronary intervention within 24 h of symptom onset in the CathPCI Registry from January 1, 2009, to June 30, 2011.

Results

Nonsystem delays occurred in 14.7% of patients (n = 12,146). Patients with nonsystem delays were more likely to be older, female, African American, and have greater comorbidities. The in-hospital mortality for patients treated without delay was 2.5% versus 15.1% for those with delay (p < 0.01). Nonsystem delay reasons included delays in providing consent (4.4%), difficult vascular access (8.4%), difficulty crossing the lesion (18.8%), “other” (31%), and cardiac arrest/intubation (37.4%). Cardiac arrest/intubation delays had the highest in-hospital mortality (29.9%) despite the shortest time delay (median D2BT: 84 min; 25th to 75th percentile: 64 to 108 min); delays in providing consent had a relatively lower in-hospital mortality rate (9.4%) despite the longest time delay (median D2BT: 100 min; 25th to 75th percentile: 80 to 131 min). Mortality for delays due to difficult vascular access, difficulty crossing a lesion, and other was also higher (8.0%, 5.6%, and 5.9%, respectively) compared with nondelayed patients (p < 0.0001). After adjustment for baseline characteristics, in-hospital mortality remained higher for patients with nonsystem delays.

Conclusions

Nonsystem reasons for delay in D2BT in ST-segment elevation myocardial infarction patients presenting for primary percutaneous coronary intervention are common and associated with high in-hospital mortality.

Key Words

delay
door-to-balloon time
mortality
STEMI

Abbreviations and Acronyms

CHF
congestive heart failure
D2BT
door-to-balloon time
IABP
intra-aortic balloon pump
IQR
interquartile range
OR
odds ratio
PCI
percutaneous coronary intervention
PVD
peripheral vascular disease
STEMI
ST-segment elevation myocardial infarction
TIMI
Thrombolysis In Myocardial Infarction

Cited by (0)

This research was supported by the American College of Cardiology Foundation's National Cardiovascular Data Registry. The views expressed in this paper represent those of the authors and do not necessarily represent the official views of the National Cardiovascular Data Registry or its associated professional societies identified at www.ncdr.com. CathPCI Registry is an initiative of the American College of Cardiology Foundation and the Society for Cardiovascular Angiography and Interventions. Dr. Feldman is a member of speaker's bureau for Abbott Vascular, Eli Lilly and Company, Daiichi Sankyo, The Medicines Company, and Bristol-Myers Squibb; and is a consultant for Maquet Cardiovascular and Gilead Sciences. Dr. Wang has received research grant support from Bristol-Myers Squibb, Daiichi Sankyo, Heartscape, Eli Lily and Company, Sanofi Aventis, Merck, and The Medicines Company; has served as a consultant for Medco and American College of Cardiology Foundation; and has performed educational activities for AstraZeneca.

All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.