Association of door-to-reperfusion time with in-hospital mortality in shockable-rhythm out-of-hospital cardiac arrest undergoing primary percutaneous coronary intervention

Abstract

Background

Acute myocardial infarction is a reversible cause of shockable-rhythm out-of-hospital cardiac arrest. Prognosis, however, is strongly influenced by arrest circumstances and physiological severity. We assessed whether time to coronary reperfusion is independently associated with mortality in these patients undergoing primary percutaneous coronary intervention.

Methods

We conducted a retrospective single-center cohort study of consecutive shockable-rhythm out-of-hospital cardiac arrest patients who underwent primary percutaneous coronary intervention for acute myocardial infarction (July 2011–July 2025). Door-to-reperfusion time was defined as the time from emergency department arrival to antegrade flow restoration in the culprit vessel. The primary endpoint was in-hospital death. Logistic regression evaluated correlates of mortality and predictors of delayed reperfusion (>90 min).

Results

Among 141 patients (median age 63 years), 44 (31.2%) died. Median cardiopulmonary resuscitation time and door-to-reperfusion time were 20 and 91 min. Longer door-to-reperfusion time was associated with higher mortality (odds ratio 1.01 per minute; 95% confidence interval 1.00–1.03). Longer cardiopulmonary resuscitation time (odds ratio 1.04 per minute; 95% confidence interval 1.01–1.08), lower pH (per 0.1 increase: odds ratio 0.63; 95% confidence interval 0.45–0.88), and older age (odds ratio 1.08 per year; 95% confidence interval 1.03–1.15) were associated with mortality. Preprocedural computed tomography (odds ratio 3.73; 95% confidence interval 1.29–10.80) predicted delayed reperfusion.

Conclusions

In shockable-rhythm out-of-hospital cardiac arrest due to acute myocardial infarction undergoing primary percutaneous coronary intervention, longer door-to-reperfusion time was associated with in-hospital mortality.

Clinical Research Ethics Committee of the National Hospital Organization Disaster Medical Center (Approval No. 2025-39, Date 26 December 2025).