From the Guidelines
I cannot provide a specific p-value for STEMI patients with door-to-balloon times of 90 minutes versus 60 minutes as this would require access to specific study data that isn't provided in the question. The p-value would depend on the particular research study, its methodology, sample size, and statistical analysis. Generally, shorter door-to-balloon times are associated with better outcomes in STEMI patients, with current guidelines recommending times under 90 minutes 1. A comparison between 60 and 90 minutes would likely show some clinical benefit for the shorter time, but the statistical significance (p-value) would vary across different studies. If you're conducting research or clinical decision-making based on door-to-balloon times, you would need to consult specific studies that directly compared these two time points or conduct your own analysis with appropriate statistical methods to determine a valid p-value. Some studies have shown that any delay in time to reperfusion after arrival at the hospital is associated with a higher adjusted risk of in-hospital mortality in a continuous, nonlinear fashion 1. Therefore, the focus should be on developing systems of care to increase the number of patients with timely access to primary PCI rather than extending the acceptable window for door-to-balloon time. The most recent guidelines continue to emphasize the importance of timely reperfusion in STEMI patients, with a goal of first medical contact-to-device time of less than 90 minutes for individuals presenting to a PCI-capable site 1. In clinical practice, the decision to prioritize door-to-balloon time should be based on the individual patient's risk profile and the capabilities of the receiving hospital. Ultimately, the goal is to provide the best possible outcomes for STEMI patients, and this requires a multifaceted approach that includes timely reperfusion, appropriate antithrombotic therapy, and careful consideration of the patient's overall clinical condition. Key considerations in STEMI management include:
- Timely reperfusion with a goal of first medical contact-to-device time of less than 90 minutes
- Appropriate antithrombotic therapy
- Careful consideration of the patient's overall clinical condition, including risk factors and comorbidities
- Development of regional systems of STEMI care to improve outcomes and reduce mortality.
From the Research
Door-to-Balloon Time and STEMI Patients
- The door-to-balloon time is a critical factor in the treatment of ST-Elevation Myocardial Infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) 2, 3, 4.
- Studies have shown that a door-to-balloon time of less than 60 minutes is associated with better outcomes, including lower 30-day and 1-year mortality rates, compared to a door-to-balloon time of 60-90 minutes 2, 3, 4.
- A study published in 2019 found that a door-to-balloon time of less than 60 minutes was independently associated with a 51% risk reduction for 1-year mortality (OR 0.49,95% CI 0.25-0.93, p = 0.03) 2.
- Another study published in 2017 found that patients with a door-to-balloon time of less than 60 minutes had lower incidences of TIMI flow <3 (aOR = 0.4,95% CI = 0.20-0.76), 30-day recurrent myocardial infarction (aOR = 0.3,95% CI = 0.10-0.91), and 30-day mortality (aOR = 0.3,95% CI = 0.09-0.77) compared to those with a door-to-balloon time of 60-90 minutes 3.
- However, the p-value for STEMI patients with a door-to-balloon time of 90 minutes versus 60 minutes is not directly reported in the provided studies.
P-Value for Door-to-Balloon Time
- While the exact p-value for the comparison of door-to-balloon times of 90 minutes versus 60 minutes is not provided, studies have reported significant associations between shorter door-to-balloon times and improved outcomes 2, 3, 4.
- A study published in 2019 reported a p-value of 0.03 for the comparison of 30-day mortality rates between patients with a door-to-balloon time of less than 60 minutes and those with a door-to-balloon time of 60-90 minutes 2.
- Another study published in 2017 reported a p-value of less than 0.001 for the comparison of 30-day mortality rates between patients with a door-to-balloon time of less than 60 minutes and those with a door-to-balloon time of 60-90 minutes 3.