OBJECTIVE: To evaluate the consequence of treatment delay of primary percutaneous coronary intervention (PPCI) on long-term survival. BACKGROUND: Network organisation based on early recognition, shortening prehospital time delays and procedural delays is the cornerstone of optimal clinical results in the acute phase of ST-segment elevation myocardial infarction (STEMI). Nevertheless, the evidence of a relationship between symptom onset-to-balloon time and mortality is weak, and few long-term data are available. SETTING AND MEASURES: In this single-centre observational follow-up study, we evaluated the long-term survival of 790 consecutive STEMI patients (mean age 68 ± 13 years; 73% males) undergoing PPCI ≤ 12 h from symptom onset, or 12-36 h in the case of persistence of symptoms or hemodynamic instability. RESULTS: The median (IQR) treatment delay, defined as the time from symptom onset to reperfusion, was 180 min (120;310), fairly balanced between patient delay (80 min (40;140)) and system delay (80 min (60-114)). Patients with a treatment delay <180 min displayed lower mortality at 1, 3, 5 and 7 years (12%, 17%, 22% and 26%, respectively) than those with a treatment delay >180 min (15%, 24%, 28% and 37%, respectively). The HR was 0.7 (95% CI 0.5 to 0.9). On univariate and stepwise multiple regression analysis, field triage and transportation (p=0.0001), shorter distance from hospital (p=0.02) and male gender (p=0.02), but not clinical variables, were independent predictors of shorter treatment delay. CONCLUSIONS: Shorter symptom onset-to-balloon time predicts long-term lower mortality in STEMI patients treated with PPCI. Our findings emphasise the need to minimise any component of treatment delay.
OBJECTIVE: To evaluate the consequence of treatment delay of primary percutaneous coronary intervention (PPCI) on long-term survival. BACKGROUND: Network organisation based on early recognition, shortening prehospital time delays and procedural delays is the cornerstone of optimal clinical results in the acute phase of ST-segment elevation myocardial infarction (STEMI). Nevertheless, the evidence of a relationship between symptom onset-to-balloon time and mortality is weak, and few long-term data are available. SETTING AND MEASURES: In this single-centre observational follow-up study, we evaluated the long-term survival of 790 consecutive STEMI patients (mean age 68 ± 13 years; 73% males) undergoing PPCI ≤ 12 h from symptom onset, or 12-36 h in the case of persistence of symptoms or hemodynamic instability. RESULTS: The median (IQR) treatment delay, defined as the time from symptom onset to reperfusion, was 180 min (120;310), fairly balanced between patient delay (80 min (40;140)) and system delay (80 min (60-114)). Patients with a treatment delay <180 min displayed lower mortality at 1, 3, 5 and 7 years (12%, 17%, 22% and 26%, respectively) than those with a treatment delay >180 min (15%, 24%, 28% and 37%, respectively). The HR was 0.7 (95% CI 0.5 to 0.9). On univariate and stepwise multiple regression analysis, field triage and transportation (p=0.0001), shorter distance from hospital (p=0.02) and male gender (p=0.02), but not clinical variables, were independent predictors of shorter treatment delay. CONCLUSIONS: Shorter symptom onset-to-balloon time predicts long-term lower mortality in STEMI patients treated with PPCI. Our findings emphasise the need to minimise any component of treatment delay.
Authors: Jae Phil Na; Kyu Chul Shin; Seunghwan Kim; Yoo Seok Park; Sung Phil Chung; In Cheol Park; Joon Min Park; Min Joung Kim Journal: Yonsei Med J Date: 2014-04-01 Impact factor: 2.759
Authors: Dong Ho Shin; Hyun Jae Kang; Jae Sik Jang; Keon Woong Moon; Young Bin Song; Duk Woo Park; Jang Whan Bae; Juhan Kim; Seung Ho Hur; Byung Ok Kim; Dong Woon Jeon; Donghoon Choi; Kyoo Rok Han Journal: Korean Circ J Date: 2019-06-21 Impact factor: 3.243
Authors: Oluwaseyi Bolorunduro; Blake Smith; Mason Chumpia; Poojitha Valasareddy; Mark R Heckle; Rami N Khouzam; Guy L Reed; Uzoma N Ibebuogu Journal: J Am Heart Assoc Date: 2016-09-30 Impact factor: 5.501