Impact of transition of thrombolysis to primary PCI on door-to-balloon time and on mortality. A population study of STEMI patients in Belgium

Purpose: Although several randomised trials have demonstrated that transferring ST Elevation Myocardial Infarction (STEMI) patients for primary Percutaneous Coronary Intervention (p PCI) leads to better outcomes than administration of thrombolytic therapy at community hospitals, transfer delays are frequently longer outside the context of a study protocol. The present study evaluates temporal changes in Door-To-Balloon times (DTB) and in hospital mortality since the implementation of STEMI network program in 2007 in Belgium. Methods: Door-to-balloon time, defined as time between diagnosis and first balloon inflation, reperfusion strategy, baseline risk profile (TIMI risk score) and in hospital mortality were prospectively recorded in 13516 Belgian STEMI patients admitted in 25 PCI centres and 47 community hospitals in the period 2007-2012. Results: Over time, pPCI increased from 89% to 96% in the PCI centres and from 56% to 88% in the community hospitals. Parallel to this transition from thrombolysis to pPCI, the proportion of patients with prolonged DTB (>120min) increased from 11% tot 15% and in the subgroup of patients with an early ( 90min doubled from 10 to 20%.(see table) Prolonged DTB was associated with an increased risk of in hospital mortality (adjusted RR 1.7, 95% CI 1.2-2.4). Despite decrease in TIMI risk score and higher use of pPCI, the in hospital mortality did not change significantly over time. View this table: Temporal changes Conclusion: The transition of thrombolysis to transfer for pPCI in the setting of a STEMI network was associated with almost 50% increase of the proportion of patients with prolonged DTB, which might have off-set the mortality benefit expected from increased pPCI use.