Symptom-to-Balloon Time is a Strong Predictor of Adverse Events Following Primary Percutaneous Coronary Intervention: Results From the Australian Capital Territory PCI Registry

详细信息    查看全文

• 作者：Jaya Chandrasekhar ; MBBS^a ; Paul Marley ; Dip App Sci^a ; Christopher Allada ; MBBS^a ; Darryl McGill ; MBBS ; PhD^a ; Simon O&rsquo ; Connor ; MBBS^a ; Moyazur Rahman ; MBBS^a ; Ren Tan ; MBBS^a ; Ata Doost Hosseiny ; MD^a ; Bruce Shadbolt ; PhD^b ; ^c ; Ahmad Farshid ; BMBS^a ; ^c ; ^{afarshid@tpg.com.au}
• 关键词：ST elevation myocardial infarction ; Primary PCI ; Symptom-to-balloon time ; Time to treatment ; Door-to-balloon time ; Major adverse cardiovascular events
• 刊名：Heart, Lung and Circulation
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：26
• 期：1
• 页码：41-48
• 全文大小：710 K
• 卷排序：26

文摘

Notwithstanding improvements in door-to-balloon time, adverse event rates after primary PCI have remained steady. We analysed the effect of symptom-to-balloon (STB) time, a reflection of total ischaemic time, on major adverse cardiovascular events (MACE) and explored predictors of prolonged STB time.MethodsThe study population included 1002 consecutive patients (22.4% women) with a mean age of 62.3±13.2 years, who underwent primary PCI during 2008-2014. Groups were compared for STB ≤ and >240 min. Primary endpoint was one-year MACE, a composite of death, reinfarction, stent thrombosis or target vessel revascularisation.ResultsSymptom-to-balloon time was available in 893 patients of which 588 (65.8%) had STB ≤240 min and 305 (34.2%) had STB >240 min. The incidence of one-year MACE increased significantly in a stepwise manner with increasing STB time (p for trend=0.003). Symptom-to-balloon time was an independent predictor of one-year MACE along with age >70 years, final TIMI flow <3, three vessel disease, cardiogenic shock and out-of-hospital cardiac arrest. We also performed a multivariate analysis to determine predictors of delayed treatment. Predictors of STB time >240 min were age >70 years, female gender, diabetes, absence of prehospital catheter laboratory activation and presentation to a non-PCI centre.ConclusionIncidence of MACE was strongly correlated with STB time and STB time was an independent predictor of MACE. We have identified specific subgroups with prolonged STB times (age >70, female gender, diabetes, absence of prehospital activation and presentation to a non-PCI centre). This information should inform future studies and strategies to minimise delays in these subgroups for improved outcomes.