{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T20:27:31Z","timestamp":1787603251922,"version":"build-2736575974"},"reference-count":20,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2020,9]]},"abstract":"<jats:sec>\n            <jats:title>Background:<\/jats:title>\n            <jats:p>For patients presenting with ST-segment\u2013elevation myocardial infarction, national quality initiatives monitor hospitals\u2019 proportion of cases with door-to-balloon (D2B) time under 90 minutes. Hospitals are allowed to exclude patients from reporting and may modify behavior to improve performance. We sought to identify whether there is a discontinuity in the number of cases included in the D2B time metric at 90 minutes and whether operators were increasingly likely to pursue femoral access in patients with less time to meet the 90-minute quality metric.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods:<\/jats:title>\n            <jats:p>Adult patients with ST-segment\u2013elevation myocardial infarction undergoing primary percutaneous coronary intervention from 2011 to 2018 were identified from the Cardiac Care Outcomes Assessment Program, a quality improvement registry in Washington state. We used the regression discontinuity framework to test for discontinuity at 90 minutes among the included cases. We defined a novel variable, remaining D2B as 90 minutes minus the time between hospital arrival and catheterization laboratory arrival. We estimated multivariable logistic regression models to assess the relationship between remaining D2B time and access site.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>\n              A total of 19\u2009348 patients underwent primary percutaneous coronary intervention and were included in the analysis. Overall, 7436 (38.4%) were excluded from the metric. There appeared to be a visual discontinuity in included cases around 90 minutes; however, local quadratic regression around the 90-minute cutoff did not reveal evidence of a significant discontinuity (\n              <jats:italic>P<\/jats:italic>\n              =0.66). Multivariable analysis showed no significant relationship between remaining D2B time and the odds of undergoing femoral access (\n              <jats:italic>P<\/jats:italic>\n              =0.73).\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>Among patients undergoing percutaneous coronary intervention for ST-segment\u2013elevation myocardial infarction, we did not find evidence of a statistically significant discontinuity in the frequency of included cases around 90 minutes or an increased preference for femoral access correlated with decreasing time to meet the 90-minute D2B time quality metric. Together, these findings indicate no evidence of widespread inappropriate methods to improve performance on D2B time metrics.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.120.009179","type":"journal-article","created":{"date-parts":[[2020,9,4]],"date-time":"2020-09-04T09:02:23Z","timestamp":1599210143000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":12,"title":["Association Between 90-Minute Door-to-Balloon Time, Selective Exclusion of Myocardial Infarction Cases, and Access Site Choice"],"prefix":"10.1161","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7227-6423","authenticated-orcid":true,"given":"Ashwin S.","family":"Nathan","sequence":"first","affiliation":[{"name":"Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (A.S.N., S.A.M.K., H.C.H., J.G., A.C.F.)."},{"name":"Leonard Davis Institute of Health Economics (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."},{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Swathi","family":"Raman","sequence":"additional","affiliation":[{"name":"College of Arts and Sciences (S.R., N.Y.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nancy","family":"Yang","sequence":"additional","affiliation":[{"name":"College of Arts and Sciences (S.R., N.Y.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ian","family":"Painter","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle (I.P., J.A.D., J.M.M., R.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameed Ahmed M.","family":"Khatana","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (A.S.N., S.A.M.K., H.C.H., J.G., A.C.F.)."},{"name":"Leonard Davis Institute of Health Economics (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."},{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias J.","family":"Dayoub","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."},{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."},{"name":"Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (E.J.D., P.W.G., J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3322-9568","authenticated-orcid":true,"given":"Howard C.","family":"Herrmann","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (A.S.N., S.A.M.K., H.C.H., J.G., A.C.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0564-4468","authenticated-orcid":true,"given":"Robert W.","family":"Yeh","sequence":"additional","affiliation":[{"name":"Richard and Susan Smith Center for Outcomes Research in Cardiology, Beth Israel Deaconess Medical Center, Boston, MA (R.W.Y.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7374-4292","authenticated-orcid":true,"given":"Peter W.","family":"Groeneveld","sequence":"additional","affiliation":[{"name":"Leonard Davis Institute of Health Economics (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."},{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."},{"name":"Division of General Internal Medicine, Perelman School of Medicine (P.W.G.), University of Pennsylvania, Philadelphia, PA."},{"name":"Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (E.J.D., P.W.G., J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacob A.","family":"Doll","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle (I.P., J.A.D., J.M.M., R.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James M.","family":"McCabe","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle (I.P., J.A.D., J.M.M., R.S.H.)."},{"name":"Foundation for Health Care Quality, Seattle, WA (J.M.M., R.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ravi S.","family":"Hira","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Washington, Seattle (I.P., J.A.D., J.M.M., R.S.H.)."},{"name":"Foundation for Health Care Quality, Seattle, WA (J.M.M., R.S.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8076-0098","authenticated-orcid":true,"given":"Jay","family":"Giri","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (A.S.N., S.A.M.K., H.C.H., J.G., A.C.F.)."},{"name":"Leonard Davis Institute of Health Economics (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."},{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."},{"name":"Corporal Michael J. Crescenz VA Medical Center, Philadelphia, PA (E.J.D., P.W.G., J.G.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9060-5307","authenticated-orcid":true,"given":"Alexander C.","family":"Fanaroff","sequence":"additional","affiliation":[{"name":"Cardiovascular Division, Hospital of the University of Pennsylvania, Philadelphia (A.S.N., S.A.M.K., H.C.H., J.G., A.C.F.)."},{"name":"Leonard Davis Institute of Health Economics (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."},{"name":"Penn Cardiovascular Outcomes, Quality, and Evaluative Research Center (A.S.N., S.A.M.K., E.J.D., P.W.G., J.G., A.C.F.), University of Pennsylvania, Philadelphia, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.12.072"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1161\/01.cir.100.1.14"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182742cf6"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx393"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2007.07.010"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.115.019474"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.118.008096"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1208200"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.4244\/EIJ-D-16-00124"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.113.006165"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2016.03.026"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2012.10.032"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)60292-6"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamacardio.2017.2348"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/s0003-4975(00)01391-6"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2017.07.020"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1161\/JAHA.114.000944"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.i1216"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcin.2013.03.020"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.04.003"}],"container-title":["Circulation: Cardiovascular Interventions"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ahajournals.org\/doi\/full\/10.1161\/CIRCINTERVENTIONS.120.009179","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,5,13]],"date-time":"2024-05-13T02:27:54Z","timestamp":1715567274000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ahajournals.org\/doi\/10.1161\/CIRCINTERVENTIONS.120.009179"}},"subtitle":["Insights From the Cardiac Care Outcomes Assessment Program (COAP) in Washington State"],"short-title":[],"issued":{"date-parts":[[2020,9]]},"references-count":20,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2020,9]]}},"alternative-id":["10.1161\/CIRCINTERVENTIONS.120.009179"],"URL":"https:\/\/doi.org\/10.1161\/circinterventions.120.009179","relation":{},"ISSN":["1941-7640","1941-7632"],"issn-type":[{"value":"1941-7640","type":"print"},{"value":"1941-7632","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,9]]},"assertion":[{"value":"2020-03-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-06-04","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2020-09-04","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e009179"}}