In-hospital time to treatment of patients with acute ST elevation myocardial infarction treated with primary angioplasty: determinants and outcome. Results from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte

• Published in: Heart (British Cardiac Society) Vol. 91; no. 8; pp. 1041 - 1046
• Main Authors: Zahn, R, Vogt, A, Zeymer, U, Gitt, A K, Seidl, K, Gottwik, M, Weber, M A, Niederer, W, Mödl, B, Engel, H-J, Tebbe, U, Senges, J
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and British Cardiovascular Society 01-08-2005; BMJ Publishing Group LTD; Copyright 2005 by Heart
• Subjects: acute myocardial infarction; ALKK; AMI; Angina pectoris; Angioplasty; Angioplasty, Balloon, Coronary - mortality; Angioplasty, Balloon, Coronary - standards; Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte; confidence interval; Coronary Angiography - mortality; Coronary Angiography - statistics & numerical data; door to angiography time; Emergency Medical Services - statistics & numerical data; Female; Germany - epidemiology; Heart attacks; Hospital Mortality; Hospitalization - statistics & numerical data; Humans; Interventional Cardiology and Surgery; Male; Middle Aged; Mortality; Myocardial Infarction - mortality; Myocardial Infarction - therapy; NRMI-2; odds ratio; PCI; percutaneous coronary intervention; primary angioplasty; Registries; Regression Analysis; Risk Factors; second national registry of myocardial infarction; ST elevation myocardial infarction; STEMI; thrombolysis in myocardial infarction; Time Factors; time to treatment; TIMI; Treatment Outcome; Germany
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2004.045336

Objective: To determine the predictors of time between presentation and primary angioplasty and the influence of this delay time on in-hospital mortality in clinical practice. Design: Analysis of data from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK). Patients: Data of 4815 patients registered at 80 hospitals between 1994 and 2000 were analysed. Results: Mean age of the patients was 61.4 (12.5) years. Cardiogenic shock was present in 14.1%. Mean time from admission to primary angioplasty (“door to angiography” time) was 83 (122) minutes. Logistic regression analysis showed the presence of a bundle branch block (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.15 to 3.29), prior coronary artery bypass grafting (OR 1.67, 95% CI 1.08 to 2.59), pre-hospital delay > 3 hours (OR 1.61, 95% CI 1.37 to 1.89), and female sex (OR 1.21, 95% CI 1.01 to 1.45) to be independently associated with longer door to angiography times, whereas a higher hospital volume of performing primary angioplasty (OR 0.53, 95% CI 0.46 to 0.62) and the year of the investigation (OR 0.96, 95% CI 0.92 to 1.00) were independently associated with shorter door to angiography times. Independent predictors of in-hospital mortality were cardiogenic shock (41.6% v 4.0% without cardiogenic shock, p < 0.0001), technical success (29.2% with TIMI (thrombolysis in myocardial infarction) flow < 3 v 6.5% with TIMI flow 3, p < 0.0001), age (16.5% ⩾ 70 years v 6.6% < 70, p < 0.0001), three vessel disease (16.5% v 6.8% with < 3 vessel disease, p < 0.0001), anterior location of infarction (12% v 7.4% without anterior infarction, p < 0.0001), year of inclusion (adjusted OR 0.92 per year, p  =  0.011), and volume of primary angioplasty at the hospital (11% for < 20 angioplasty procedures/year v 8.3% for ⩾ 20/year, p  =  0.027) but not the door to angiography time (adjusted OR 1.14 per tertile, p  =  0.397). Conclusions: In current clinical practice in Germany median door to angiography time is quite short (83 (122) minutes). Some patients and hospital factors are independently associated with a longer door to angiography time. Within the observed short in-hospital delays door to angiography time did not influence in-hospital mortality. However, efforts to keep them as short as possible should be continued.