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In-hospital time to treatment of patients with acute ST elevation myocardial infarction treated with primary angioplasty: determinants and outcome. Results from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte
  1. R Zahn1,
  2. A Vogt2,
  3. U Zeymer1,
  4. A K Gitt1,
  5. K Seidl1,
  6. M Gottwik3,
  7. M A Weber4,
  8. W Niederer5,
  9. B Mödl6,
  10. H-J Engel7,
  11. U Tebbe8,
  12. J Senges1,
  13. for the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte
  1. 1Herzzentrum, Kardiologie, Ludwigshafen, Germany
  2. 2Städtisches Klinikum, Kassel, Germany
  3. 3Klinikum Nürnberg Süd, Nuremberg, Germany
  4. 4Kreisklinik, Dachau, Germany
  5. 5Krankenhaus der Barmherzigen Brüder, Regensburg, Germany
  6. 6Städtisches Klinikum, Ingolstadt, Germany
  7. 7Zentralkrankenhaus “Links der Weser”, Bremen, Germany
  8. 8Klinikum Lippe Detmold, Detmold, Germany
  1. Correspondence to:
    Dr Ralf Zahn
    Herzzentrum Ludwigshafen, Department of Cardiology, Bremserstraße 79, D-67063 Ludwigshafen, Germany;


Objective: To determine the predictors of time between presentation and primary angioplasty and the influence of this delay time on in-hospital mortality in clinical practice.

Design: Analysis of data from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte (ALKK).

Patients: Data of 4815 patients registered at 80 hospitals between 1994 and 2000 were analysed.

Results: Mean age of the patients was 61.4 (12.5) years. Cardiogenic shock was present in 14.1%. Mean time from admission to primary angioplasty (“door to angiography” time) was 83 (122) minutes. Logistic regression analysis showed the presence of a bundle branch block (odds ratio (OR) 1.95, 95% confidence interval (CI) 1.15 to 3.29), prior coronary artery bypass grafting (OR 1.67, 95% CI 1.08 to 2.59), pre-hospital delay > 3 hours (OR 1.61, 95% CI 1.37 to 1.89), and female sex (OR 1.21, 95% CI 1.01 to 1.45) to be independently associated with longer door to angiography times, whereas a higher hospital volume of performing primary angioplasty (OR 0.53, 95% CI 0.46 to 0.62) and the year of the investigation (OR 0.96, 95% CI 0.92 to 1.00) were independently associated with shorter door to angiography times. Independent predictors of in-hospital mortality were cardiogenic shock (41.6% v 4.0% without cardiogenic shock, p < 0.0001), technical success (29.2% with TIMI (thrombolysis in myocardial infarction) flow < 3 v 6.5% with TIMI flow 3, p < 0.0001), age (16.5% ⩾ 70 years v 6.6% < 70, p < 0.0001), three vessel disease (16.5% v 6.8% with < 3 vessel disease, p < 0.0001), anterior location of infarction (12% v 7.4% without anterior infarction, p < 0.0001), year of inclusion (adjusted OR 0.92 per year, p  =  0.011), and volume of primary angioplasty at the hospital (11% for < 20 angioplasty procedures/year v 8.3% for ⩾ 20/year, p  =  0.027) but not the door to angiography time (adjusted OR 1.14 per tertile, p  =  0.397).

Conclusions: In current clinical practice in Germany median door to angiography time is quite short (83 (122) minutes). Some patients and hospital factors are independently associated with a longer door to angiography time. Within the observed short in-hospital delays door to angiography time did not influence in-hospital mortality. However, efforts to keep them as short as possible should be continued.

  • ALKK, Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausärzte
  • AMI, acute myocardial infarction
  • CI, confidence interval
  • NRMI-2, second national registry of myocardial infarction
  • OR, odds ratio
  • PCI, percutaneous coronary intervention
  • STEMI, ST elevation myocardial infarction
  • TIMI, thrombolysis in myocardial infarction
  • acute myocardial infarction
  • door to angiography time
  • primary angioplasty
  • time to treatment

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