Hospital improvement in time to reperfusion in patients with acute myocardial infarction, 1999 to 2002

J Am Coll Cardiol. 2006 Jan 3;47(1):45-51. doi: 10.1016/j.jacc.2005.04.071. Epub 2005 Dec 13.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Angioplasty, Balloon, Coronary*
  • Electrocardiography
  • Female
  • Guideline Adherence
  • Hospitals / statistics & numerical data*
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / physiopathology
  • Myocardial Infarction / therapy*
  • Practice Guidelines as Topic
  • Thrombolytic Therapy*
  • Time Factors
  • United States