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


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.

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