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By the end of the last decade, 24/7 primary percutaneous coronary intervention (PCI) (PPCI) for patients with ST elevation myocardial infarction (STEMI) had been established as the default therapy across most of the UK and represents one of the major success stories of British cardiology. In parallel with this development, the British Cardiovascular Intervention Society (BCIS) and the National Institute for Cardiovascular Outcomes Research (NICOR) have collaborated in the production of an extremely comprehensive annual audit report documenting the activity and outcomes of almost all the UK interventional cardiology centres. The dataset collected for each procedure includes detailed information on treatment times for patients undergoing PPCI. In their Heart publication, Varcoe et al on behalf of BCIS and NICOR have used this treasure trove to generate an analysis of the influence of treatment time delays on 30-day mortality in a cohort of 16 907 consecutive patients in England and Wales undergoing PPCI in 2011, all of whom had call-to-balloon (CTB) times of <6 hours.1 The investigators chose to focus mainly on CTB as the performance indicator most reflective of the efficiency of the complete patient pathway from first call for help to first device use (balloon inflation or aspiration) in the infarct-related artery.
Predictors of CTB time
The median CTB time in the whole cohort was 111 min with 81% of patients being treated within 150 min of their initial call for help. In a multivariable analysis, a number of factors were shown to predict a longer CTB time but only by a few minutes. These included increasing age, female gender, diabetes, preprocedural cardiogenic shock, better preprocedural Thrombolysis in Myocardial Infarction (TIMI) flow and femoral access. The latter is notable as some previous …
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