Trends in door‐to‐balloon time and outcomes following primary percutaneous coronary intervention for ST‐elevation myocardial infarction: an Australian perspective. Issue 5 (May 2014)

• Record Type: Journal Article
• Authors: Brennan, A. L.; Andrianopoulos, N.; Duffy, S. J.; Reid, C. M.; Clark, D. J.; Loane, P.; New, G.; Black, A.; Yan, B. P.; Brooks, M.; Roberts, L.; Carroll, E. A.; Lefkovits, J.; Ajani, A. E.
• Is Part Of: Internal medicine journal. Volume 44:Issue 5(2014)
• Page Start: 471
• Page End: 477
• Publication Date: 2014-05
• Subjects: Medicine -- Periodicals; 616
• DOI: 10.1111/imj.12405
• Languages: English
• ISSNs: 1444-0903

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="imj12405-sec-0001" sec-type="section"> <title>Background</title> <p>Guidelines for patients with ST‐elevation myocardial infarction include a door‐to‐balloon time (DTBT) of ≤90 min for primary percutaneous coronary intervention.</p> </sec> <sec id="imj12405-sec-9001" sec-type="section"> <title>Aim</title> <p>The aim of this study was to assess temporal trends (2006–2010) in DTBT and determine if a reduction in DTBT was associated with improved clinical outcomes.</p> </sec> <sec id="imj12405-sec-0002" sec-type="section"> <title>Methods</title> <p>We compared annual median DTBT in 1926 STEMI patients undergoing primary percutaneous coronary intervention from the Melbourne Interventional Group registry. ST‐elevation myocardial infarction presenting >12 h and rescue percutaneous coronary intervention was excluded. Major adverse cardiac events were analysed according to DTBT (dichotomised as ≤90 min vs >90 min). A multivariable analysis for predictors of mortality (including DTBT) was performed.</p> </sec> <sec id="imj12405-sec-0003" sec-type="section"> <title>Results</title> <p>Baseline demographics, clinical and procedural characteristics were similar in the STEMI cohort across the 5 years, apart from an increase in out‐of‐hospital cardiac arrest (3.6% in 2006 vs 9.4% in 2010, <italic>P</italic> < 0.0001) and cardiogenic shock (7.7–9.6%, <italic>P</italic> = 0.07). The median DTBT (interquartile range) was reduced from 95 (74–130) min in 2006 to 75 (51–100) min in 2010 (<italic>P</italic> < 0.01). In this period, the proportion of patients achieving a DTBT of ≤90 min increased from 45% to 67% (<italic>P</italic> < 0.01). Lower mortality and major adverse cardiac event rates were observed with DTBT ≤90 min (all <italic>P</italic> < 0.01). Multivariable analysis showed that a DTBT of ≤90 min was associated with improved clinical outcomes at 12 months (odds ratio 0.48; 95% confidence interval 0.33–0.73, <italic>P</italic> < 0.01).</p> </sec> <sec id="imj12405-sec-0004" sec-type="section"> <title>Conclusion</title> <p>There has been a decline in median DTBT in the Melbourne Interventional Group registry over 5 years. DTBT of ≤90 min is associated with improved clinical outcomes at 12 months.</p> </sec> </abstract>