# Association between door-to-wire time and 30-day mortality after PCI in patients with acute myocardial infarction: evidence from a single-center study in the China chest pain center registry

## TL;DR

This study shows that longer door-to-wire times in heart attack patients undergoing PCI are linked to higher 30-day mortality and complications.

## Contribution

The study identifies a nonlinear relationship between door-to-wire time and mortality, suggesting a critical threshold around 50 minutes.

## Key findings

- Longer door-to-wire time was associated with increased 30-day in-hospital mortality (HR 1.47 per 10-min increase).
- A nonlinear relationship was observed, with mortality risk rising after approximately 50 minutes of door-to-wire time.
- Extended door-to-wire time also increased risks of in-hospital infection and respiratory failure.

## Abstract

Door-to-wire (D2W) time may reflect the initiation of mechanical reperfusion in Acute myocardial infarction (AMI) more precisely. However, evidence on its association with short-term mortality remains limited, and the potential nonlinear or threshold relationship between D2W time and mortality has not been well characterized. This study aims to evaluate the association between D2W time and in-hospital mortality within 30 days and to explore potential nonlinear relationships.

In this retrospective cohort study, we included patients with AMI who underwent percutaneous coronary intervention (PCI) at a certified Chest Pain Center in China between January 2021 and April 2025. The primary outcome was in-hospital mortality within 30 days of admission, and secondary outcomes included intraoperative and in-hospital complications. D2W time was analyzed as a continuous exposure (per 10-min increase). Multivariable Cox proportional hazards models with restricted cubic splines (RCS) were used to characterize potential nonlinear associations between D2W time and outcomes. RCS analyses were repeated in prespecified subgroups to assess robustness.

Among 1,451 AMI patients who underwent PCI, longer D2W time was associated with a higher risk of in-hospital mortality within 30 days of admission in the fully adjusted Cox model (per 10-min increase: HR 1.47, 95% CI 1.16–1.87; P = 0.0016). RCS analyses suggested a nonlinear association, with the fitted curve reaching its lowest point at approximately 50 min and increasing thereafter. Longer D2W times were also associated with higher risks of in-hospital infection and respiratory failure. Findings were broadly consistent across prespecified subgroup analyses.

Among patients with AMI undergoing PCI, longer D2W time was associated with higher risks of 30-day in-hospital mortality and in-hospital complications. RCS analyses suggested a nonlinear association between D2W time and 30-day in-hospital mortality, and further validation in future studies is needed.