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Impact of call-to-balloon time on 30-day mortality in contemporary practice
  1. Richard W Varcoe1,
  2. Tim C Clayton2,
  3. Huon H Gray3,
  4. Mark A de Belder4,
  5. Peter F Ludman5,
  6. Robert A Henderson1
  7. on behalf of the British Cardiovascular Intervention Society (BCIS) and the National Institute for Cardiovascular Outcomes Research (NICOR)
  1. 1Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
  2. 2London School of Hygiene and Tropical Medicine, London, UK
  3. 3Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
  4. 4The James Cook University Hospital, Middlesbrough, UK
  5. 5Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK
  1. Correspondence to Dr Richard Varcoe, Trent Cardiac Centre, City Hospital Campus, Nottingham University Hospitals NHS Trust, Hucknall Road, Nottingham NG5 1PB, UK; richard.varcoe{at}


Objective Studies reporting an association between treatment delay and outcome for patients with ST segment elevation myocardial infarction (STEMI) have generally not included patients treated by a primary percutaneous coronary intervention (PPCI) service that systematically delivers reperfusion therapy to all eligible patients. We set out to determine the association of call-to-balloon (CTB) time with 30-day mortality after PPCI in a contemporary series of patients treated within a national reperfusion service.

Methods We analysed data on 16 907 consecutive patients with STEMI treated by PPCI in England and Wales in 2011 with CTB time of ≤6 hours.

Results The median CTB and door-to-balloon times were 111 and 41 min, respectively, with 80.9% of patients treated within 150 min of the call for help. An out-of-hours call time (58.2% of patients) was associated with a 10 min increase in CTB time, whereas inter-hospital transfer for PPCI (18.5% of patients) was associated with a 49 min increase in CTB time. CTB time was independently associated with 30-day mortality (p<0.0001) with a HR of 1.95 (95% CI 1.54 to 2.47) for a CTB time of >180–240 min compared with ≤90 min. The relationship between CTB time and 30-day mortality was influenced by patient risk profile with a greater absolute impact of increasing CTB time on mortality in high-risk patients.

Conclusion CTB time is a useful metric to assess the overall performance of a PPCI service. Delays to reperfusion remain important even in the era of organised national PPCI services with rapid treatment times and efforts should continue to minimise treatment delays.

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  • Contributors All listed authors fulfil the four authorship criteria as specified in the guidelines of the International Committee of Medical Journal Editors 2013. No persons other than the listed authors have made substantial contributions to this manuscript. RWV and RAH devised and planned the study; TCC performed all the statistical analyses; RWV, RAH and TCC wrote the manuscript; MAdB, HHG and PFL reviewed the manuscript and the statistical analyses and made changes to the content of the manuscript; RWV is responsible for the overall content of the manuscript and acts as guarantor.

  • Competing interests TCC has received research funding from the Medicines Company. MAdB has received travel grants from Abbott Vascular. RAH is an Advisory Board member for Quantum Imaging. RWV, HHG and PFL have no relationships with industry to declare.

  • Ethics approval National registry data.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement RWV and TCC had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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