Author + information
- Received January 13, 2005
- Revision received March 29, 2005
- Accepted April 11, 2005
- Published online January 3, 2006.
- Robert L. McNamara, MD, MHS, FACC⁎,
- Jeph Herrin, PhD⁎,§,
- Elizabeth H. Bradley, PhD†,
- Edward L. Portnay, MD⁎,
- Jeptha P. Curtis, MD⁎,
- Yongfei Wang, MS⁎,
- David J. Magid, MD, MPH∥,¶,
- Martha Blaney, PharmD#,
- Harlan M. Krumholz, MD, SM, FACC⁎,†,‡,⁎⁎,⁎ (, )
- NRMI Investigators
- ↵⁎Reprint requests and correspondence:
Dr. Harlan M. Krumholz, Yale University School of Medicine, 333 Cedar Street, PO Box 208088, New Haven, Connecticut 06520-8088.
Objectives The purpose of this study was to analyze recent trends in door-to-reperfusion time and to identify hospital characteristics associated with improved performance.
Background Rapid reperfusion improves survival for patients with acute ST-segment elevation myocardial infarction (STEMI).
Methods In this retrospective observational study from the National Registry of Myocardial Infarction (NRMI)-3 and -4, between 1999 and 2002, we analyzed door-to-needle and door-to-balloon times in patients admitted with STEMI and receiving fibrinolytic therapy (n = 68,439 patients in 1,015 hospitals) or percutaneous coronary intervention (n = 33,647 patients in 421 hospitals) within 6 h of hospital arrival.
Results In 1999, only 46% of the patients in the fibrinolytic therapy cohort were treated within the recommended 30-min door-to-needle time; only 35% of the patients in the percutaneous coronary intervention cohort were treated within the recommended 90-min door-to-balloon time. Improvement in these times to reperfusion over the four-year study period was not statistically significant (door-to-needle: −0.01 min/year, 95% confidence interval [CI] −0.24 to +0.23, p > 0.9; door-to-balloon: −0.57 min/year, 95% CI −1.24 to +0.10, p = 0.09). Only 33% (337 of 1,015) of hospitals improved door-to-needle time by more than one min/year, and 26% (110 of 421) improved door-to-balloon time by more than three min/year. No hospital characteristic was significantly associated with improvement in door-to-needle time. Only high annual percutaneous coronary intervention volume and location in New England were significantly associated with greater improvement in door-to-balloon time.
Conclusions Fewer than one-half of patients with STEMI receive reperfusion in the recommended door-to-needle or door-to-balloon time, and mean time to reperfusion has not decreased significantly in recent years. Relatively few hospitals have shown substantial improvement.
Martha Blaney is employed by Genentech Inc. This research was supported by the National Heart, Lung, and Blood Institute, R01HS10407-01. The NHLBI did not play a role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; or preparation, review, or approval of the manuscript.
- Received January 13, 2005.
- Revision received March 29, 2005.
- Accepted April 11, 2005.
- American College of Cardiology Foundation