Evidence map›Paper›PMID 19454739›Full record

ArticleBMJ (Clinical research ed.)2009

Association of door-to-balloon time and mortality in patients admitted to hospital with ST elevation myocardial infarction: national cohort study.

Saif S Rathore, Jeptha P Curtis, Jersey Chen, Yongfei Wang, Brahmajee K Nallamothu, Andrew J Epstein, Harlan M Krumholz, National Cardiovascular Data Registry

Registry-linked trialOpen access · hybridAbstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMJ (Clinical research ed.), 2009. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT03940443 (Differences in Mortality and Morbidity in Patients Suffering a Time-critical Condition Between Ground Emergency Medical Services and Helicopter Emergency Medical Services - a Descriptive and Comparative Study), which is not on this map. Cited by 144 papers, 5 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
144citing papers in PubMed, 5 pooled it
26.8field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT03940443 unknown statusnot on this mapstarted 2019, after this paper: background citation

Differences in Mortality and Morbidity in Patients Suffering a Time-critical Condition Between Ground Emergency Medical Services and Helicopter Emergency Medical Services - a Descriptive and Comparative Study

TypeobservationalSponsorDalarna County Council, SwedenRan2019 to 2021Enrolled2,000ConditionsAmbulances, Traumatic Brain Injury, Acute Myocardial Infarction
3 · Its place in the literature

Who cites it

144 citing papers in PubMed, 5 syntheses or guidelines pooled it, 478 citations in OpenAlex.

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84 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

8 authors at 3 institutions in 1 country.

Saif S RathoreYale University School of Medicine, 367 Cedar Street, 316 ESH, New Haven, Connecticut 06510, USA. saif.rathore@yale.edu
Jeptha P Curtis
Jersey Chen
Yongfei Wang
Brahmajee K Nallamothu
Andrew J Epstein
Harlan M Krumholz
National Cardiovascular Data Registry
Yale University · USYale New Haven Hospital · USUniversity of Michigan–Ann Arbor · US

Funding

YALE UNIVERSITY CLINICAL AND TRANSLATIONAL SCIENCE AWARD PROGRAMUL1RR024139 · NCRR · YALE UNIVERSITY · PI SHERWIN, ROBERT S · 2006 to 2011
$56.8M
MEDICAL SCIENTIST TRAINING PROGRAMT32GM007205 · NIGMS · YALE UNIVERSITY · PI KAZMIERCZAK, BARBARA I · 1985 to 2019
$42.9M
NCRR NIH HHS UL1 RR024139NIGMS NIH HHS 5T32GM07205NIGMS NIH HHS T32 GM007205
6 · The paper itself

Abstract

objectiveTo evaluate the association between door-to-balloon time and mortality in hospital in patients undergoing primary percutaneous coronary intervention for ST elevation myocardial infarction to assess the incremental mortality benefit of reductions in door-to-balloon times of less than 90 minutes.

designProspective cohort study of patients enrolled in the American College of Cardiology National Cardiovascular Data Registry, 2005-6.

settingAcute care hospitals.

participants43 801 patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention.

main outcome measureMortality in hospital.

resultsMedian door-to-balloon time was 83 minutes (interquartile range 6-109, 57.9% treated within 90 minutes). Overall mortality in hospital was 4.6%. Multivariable logistic regression models with fractional polynomial models indicated that longer door-to-balloon times were associated with a higher adjusted risk of mortality in hospital in a continuous non-linear fashion (30 minutes=3.0%, 60 minutes=3.5%, 90 minutes=4.3%, 120 minutes=5.6%, 150 minutes=7.0%, 180 minutes=8.4%, P<0.001). A reduction in door-to-balloon time from 90 minutes to 60 minutes was associated with 0.8% lower mortality, and a reduction from 60 minutes to 30 minutes with a 0.5% lower mortality.

conclusionAny delay in primary percutaneous coronary intervention after a patient arrives at hospital is associated with higher mortality in hospital in those admitted with ST elevation myocardial infarction. Time to treatment should be as short as possible, even in centres currently providing primary percutaneous coronary intervention within 90 minutes.

Indexed as

AgedAngioplasty, BalloonCohort StudiesEmergency TreatmentFemaleHospitalizationHospital MortalityHumansMaleMiddle AgedMyocardial InfarctionTime FactorsTransportation of PatientsUnited States

Identifiers

PMID19454739
PMCPMC2684578
OpenAlexW2010615823

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.