Is there an age difference between patients with a door-to-balloon (D2B) time of 60 minutes versus 90 minutes?

From the Guidelines

Based on the information provided, I cannot determine if there was an age difference between patients with a door-to-balloon time of 60 minutes versus 90 minutes. The question asks about a specific comparison between two patient groups defined by different door-to-balloon times, but no data has been provided regarding the age demographics of these groups. Door-to-balloon time refers to the interval between a patient's arrival at the hospital and the restoration of blood flow during primary percutaneous coronary intervention (PCI) for acute myocardial infarction. While shorter door-to-balloon times (such as 60 minutes) are generally associated with better clinical outcomes compared to longer times (such as 90 minutes), the relationship between door-to-balloon times and patient age would require specific clinical data to analyze, as noted in the 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction 1.

Some key points to consider in the management of ST-elevation myocardial infarction include:

• The goal of achieving a door-to-balloon time of 90 minutes or less, as recommended by the ACC/AHA guidelines 1
• The importance of minimizing total ischemic time, which is defined as the time from onset of symptoms of STEMI to initiation of reperfusion therapy, as emphasized in the 2007 focused update of the ACC/AHA guidelines 1
• The role of primary PCI as the preferred reperfusion strategy in STEMI, if performed in a timely fashion, as stated in the 2004 ACC/AHA guidelines 1 and the 2013 ACCF/AHA guideline 1
• The consideration of patient variables, such as uncertainty about diagnosis, evaluation and treatment of other life-threatening conditions, obtaining informed consent, and anatomical challenges, that may delay the patient’s arrival in the interventional cardiology laboratory or prolong the PCI procedure, as noted in the 2007 focused update of the ACC/AHA guidelines 1 and the 2013 ACCF/AHA guideline 1

Age could potentially be a confounding factor in door-to-balloon times, as elderly patients might present with atypical symptoms leading to delayed diagnosis, or might have more complex coronary anatomy requiring longer procedural times, but this would need to be confirmed with actual patient data, as suggested by the Vienna STEMI registry 1. However, without specific data on the age demographics of patients with door-to-balloon times of 60 minutes versus 90 minutes, it is not possible to determine if there is an age difference between these groups.

From the Research

Age Difference in D2B Time

• The study 2 analyzed 5243 patients with ST-segment-elevation myocardial infarction and found that the median door-to-balloon (D2B) time was 59 minutes, with 92.2% of patients having a D2B time of 90 minutes or less.
• However, this study does not provide a direct comparison of age between patients with a D2B time of 60 minutes versus 90 minutes.
• Another study 3 found that patients in the "thrombolytic then PCI" group were younger, but this study does not specifically compare D2B times of 60 minutes versus 90 minutes.
• The remaining studies 4, 5, 6 do not provide information on age differences between patients with D2B times of 60 minutes versus 90 minutes.

Prognostic Implications of D2B Time

• The study 2 found that shortening D2B time was significantly associated with survival benefit, and this benefit was consistently observed even for D2B times less than 60 to 90 minutes.
• The study 6 found that a decline in D2B time was not associated with an improvement in clinical outcomes, including in-hospital mortality.
• The other studies 3, 4, 5 do not provide direct information on the prognostic implications of D2B time in relation to age differences between patients with D2B times of 60 minutes versus 90 minutes.

Clinical Outcomes

• The study 2 found that reducing D2B time within 45 minutes showed a further decreased risk of mortality compared with D2B time greater than 90 minutes.
• The study 5 found that patients with prior coronary artery bypass grafting had poor in-hospital outcomes, with low PCI success rates and high mortality, but this study does not specifically compare D2B times of 60 minutes versus 90 minutes.
• The remaining studies 3, 4, 6 do not provide information on clinical outcomes specifically related to age differences between patients with D2B times of 60 minutes versus 90 minutes.