Abstract 360: Association Between Door-To-Balloon Time on Mortality in Patients With ST-Elevation Myocardial Infarction and Cardiac Arrest
Background: Door-to-balloon-time (D2BT) is a national hospital metric for quality of care among patients with ST-elevation myocardial infarction (STEMI) but STEMI patients with cardiac arrest (CA) are excluded from D2BT public reporting metrics. The association of D2BT with mortality in STEMI patients with cardiac arrest (CA) in the contemporary era of rapid primary PCI is unknown. We assessed the association of D2BT and outcomes in patients with STEMI+CA. Methods: We reviewed consecutive cases of STEMI and CA, defined as loss of pulse requiring cardiopulmonary resuscitation and/or defibrillation, treated with percutaneous coronary intervention (PCI) at our center from 1/1/11-12/31/16.We assessed characteristics and outcomes among these patients by quartile of D2BT (Q1: 21-82 minutes, Q2: 83-106 minutes, Q3: 109-139 minutes, Q4: 141-489 minutes). Results: We identified 145 patients with STEMI+CA. Increasing quartiles of D2BT were associated with higher proportion of female sex (p=0.040), Caucasian race (p=0.001), and dyslipidemia (p=0.008). The use of guideline-directed medical therapy prior to PCI (aspirin, P2Y12 inhibitor, and anticoagulant) and the occurrence of in-hospital post-PCI adverse events were similar between groups. We observed a trend toward increased in-hospital mortality associated with increasing D2BT (Q1: 8.3%, Q2: 10.8%, Q3: 19.4%, Q4: 22.2%, p=0.059, Figure). Conclusion: D2BT is associated with in-hospital mortality among patients with STEMI+CA. Efforts should be made to implement systems of care to reduce disparities in D2BT among appropriate patients within this population.