Observational studyBMJ open2026
Association between door-to-balloon time ≤60 minutes and short- and long-term outcomes in patients with ST-segment elevation myocardial infarction: a retrospective cohort study.
Observational study in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCurrent guidelines diverge on the optimal door-to-balloon time (DTBT) for acute ST-segment elevation myocardial infarction (STEMI), and whether a ≤60 min target benefits all patients equally remains unclear.
objectivesThis study aimed to investigate whether the association between DTBT ≤60 min and short- and long-term prognosis in STEMI patients varies by Global Registry of Acute Coronary Events (GRACE) risk score.
designRetrospective cohort study.
settingSingle high-volume tertiary cardiology centre in China.
participantsThis study initially included 5516 STEMI patients undergoing primary percutaneous coronary intervention (PPCI) treatment. 4513 were included after applying inclusion criteria (age >18 years, presentation within 12 hours of symptom onset, complete medical records) and exclusion criteria (symptom duration ≥12 hours, failure to receive PPCI, incomplete outcome data).
interventionsNot applicable (observational study). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcomes were in-hospital, 1-year and 3-year all-cause mortality. Secondary outcomes included major adverse cardiovascular and cerebrovascular events (MACCE) at 1 and 3 years post-discharge.
resultsAmong 4513 STEMI patients, 2433 (54.0%) were high-risk (HR-STEMI) and 2080 (46.0%) low-risk (LR-STEMI). DTBT ≤60 min was achieved in 45.7% of HR-STEMI and 52.0% of LR-STEMI patients. For HR-STEMI patients, DTBT >60 min was associated with significantly higher risks of in-hospital mortality (OR=2.381, 95% CI 1.160 to 4.883, p=0.018), 1-year mortality (HR=1.715, 95% CI 1.194 to 2.464, p=0.003), 1-year MACCE (HR=1.212, 95% CI 1.001 to 1.467, p=0.049), 3-year mortality (HR=1.689, 95% CI 1.267 to 2.253, p<0.001), and 3-year MACCE (HR=1.230, 95% CI 1.042 to 1.453, p=0.014). Among LR-STEMI patients, no significant differences were observed between DTBT groups.
conclusionsDTBT ≤60 min was significantly associated with better short- and long-term outcomes, particularly in patients with GRACE >140. Sensitivity analysis suggested that the benefit may also extend to patients with GRACE scores between 120 and 140. TRIAL REGISTRATION NUMBER: Not applicable (observational study).
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