Symptom onset-to-balloon time and mortality in the first seven years after STEMI treated with primary percutaneous coronary intervention
- Daniela Rollando1,
- Enrico Puggioni1,
- Stefano Robotti1,
- Angelo De Lisi1,
- Maura Ferrari Bravo2,
- Adriana Vardanega3,
- Ivo Pattaro1,
- Federica De Benedetti1,
- Michele Brignole1
- 1Department of Cardiology, Ospedali del Tigullio, Lavagna, Italy
- 2Department of Prevention, ASL4 “Chiavarese”, Chiavari, Italy
- 3Department of Information Technology, ASL 4 “Chiavarese”, Chiavari, Italy
- Correspondence to Professor Michele Brignole, Department of Cardiology, Ospedali del Tigullio, Lavagna 16033, Italy; mbrignole{at}ASL4.liguria.it
- Accepted 3 September 2012
- Published Online First 28 September 2012
Abstract
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.
