Symptom onset-to-balloon time and mortality in the first seven years after STEMI treated with primary percutaneous coronary intervention

Rollando, Daniela; Puggioni, Enrico; Robotti, Stefano; Lisi, Angelo De; Bravo, Maura Ferrari; Vardanega, A.; Pattaro, Ivo; Benedetti, Fabrizio; Brignole, Michele

doi:10.1136/heartjnl-2012-302536

Cited by 55 publications

(42 citation statements)

References 30 publications

(21 reference statements)

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“…In rural areas, the reduction of time to definitive treatment often relies on air transportation in patients with, e.g., ST‐elevation, myocardial infarction, or stroke. The reduction of time from occlusion to open vessel is the most important predictor of good functional outcome . As such, our study likely underestimates the proportion of missions that can be classified as beneficial.…”

Section: Discussionmentioning

confidence: 89%

Pre‐hospital critical care by anaesthesiologist‐staffed pre‐hospital services in Scandinavia: a prospective population‐based study

Krüger

Lossius

Mikkelsen

et al. 2013

Acta Anaesthesiol Scand

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Section: Discussionmentioning

confidence: 89%

Pre‐hospital critical care by anaesthesiologist‐staffed pre‐hospital services in Scandinavia: a prospective population‐based study

Krüger

Lossius

Mikkelsen

et al. 2013

Acta Anaesthesiol Scand

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“…A binary outcome variable, "late presentation," was defined as a SODT >180 minutes based on data from prior studies. [14][15][16] A multivariate logistic regression analysis was then conducted to assess for the effect of race on "late presentation"…”

Section: Methodsmentioning

confidence: 99%

Racial Difference in Symptom Onset to Door Time in ST Elevation Myocardial Infarction

Bolorunduro

Smith

Chumpia

et al. 2016

JAHA

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BackgroundThere are poorer outcomes following ST elevation myocardial infarction in blacks compared to white patients despite comparable door‐to‐reperfusion time. We hypothesized that delays to hospital presentation may be contributory.Methods and ResultsWe conducted a retrospective analysis of the 1144 patients admitted for STEMI in our institution from 2008 to 2013. The door‐to‐balloon time (D2BT) and symptom‐onset‐to‐door time (SODT) were compared by race. Bivariate analysis was done comparing the median D2BT and SODT. Stratified analyses were done to evaluate the effect of race on D2BT and SODT, accounting for insurance status, age, sex and comorbidities. The mean age was 59±13 years; 56% of this population was black and 41% was white. Males accounted for 66% of this population. The median D2BT was 60 minutes (interquartile range [IQR] 42–82), and median SODT was 120 minutes (IQR 60–720). There was no significant difference in D2BT by race (P=0.86). Black patients presented to the emergency room (ER) later than whites (SODT=180 [IQR 60–1400] vs 120 [IQR 60–560] minutes, P<0.01) and were more likely to be uninsured (P<0.01). After controlling for comorbidities, insurance, and socioeconomic status, blacks were 60% more likely to present late after a STEMI (OR 1.6, P<0.01). A subset analysis excluding transferred patients showed similar results.ConclusionsBlack patients present later to the ER after STEMI with no difference in D2BT compared to whites. This difference in time to presentation may be one of the factors accounting for poor outcomes in this population.

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“…Currently, a patient's condition, such as progression of the disease and heart failure on presentation, are considered more important to treatment outcomes 35,36. Recently, some have postulated that the time from the onset of symptoms to reperfusion is a more important determinant of outcomes than door-to-balloon time 33,37. Decreasing delays due to patients is a difficult problem because it requires reducing pre-hospital time.…”

Section: Discussionmentioning

confidence: 99%

Performance of Reperfusion Therapy and Hospital Mortality in ST-Elevation Myocardial Infarction Patients with Non-Chest Pain Complaints

Shin

Kim

et al. 2014

Yonsei Med J

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PurposeST-elevation myocardial infarction (STEMI) patients may visit the emergency department (ED) complaining of sensations of pain other than the chest. We investigated our performance of reperfusion therapy for STEMI patients presenting with non-chest pains.Materials and MethodsThis was a retrospective observational cohort study. STEMI patients who underwent primary percutaneous coronary intervention (PCI) were divided into a chest pain group and a non-chest pain group. Clinical differences between the two groups and the influence of presenting with non-chest pains on door-to-electrocardiograms (ECG) time, door-to-balloon time, and hospital mortality were evaluated.ResultsOf the 513 patients diagnosed with STEMI, 93 patients presented with non-chest pains. Patients in the non-chest pain group were older, more often female, and had a longer symptom onset to ED arrival time and higher Killip class than patients in the chest pain group. There was a statistically significant delay in door-to-ECG time (median, 2.0 min vs. 5.0 min; p<0.001) and door-to-balloon time (median, 57.5 min vs. 65.0 min; p<0.001) in patients without chest pain. In multivariate analysis, presenting with non-chest pains was an independent predictor for hospital mortality (odds ratio, 2.3; 95% confidence interval, 1.1-4.7). However, door-to-ECG time and door-to-balloon time were not factors related to hospital mortality.ConclusionSTEMI patients presenting without chest pain showed higher baseline risk and hospital mortality than patients presenting with chest pain. ECG acquisition and primary PCI was delayed for patients presenting with non-chest pains, but not influencing hospital mortality. Efforts to reduce pre-hospital time delay for these patients are necessary.

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Symptom onset-to-balloon time and mortality in the first seven years after STEMI treated with primary percutaneous coronary intervention

Abstract: 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.

Cited by 55 publications

References 30 publications

Pre‐hospital critical care by anaesthesiologist‐staffed pre‐hospital services in Scandinavia: a prospective population‐based study

Pre‐hospital critical care by anaesthesiologist‐staffed pre‐hospital services in Scandinavia: a prospective population‐based study

Racial Difference in Symptom Onset to Door Time in ST Elevation Myocardial Infarction

Performance of Reperfusion Therapy and Hospital Mortality in ST-Elevation Myocardial Infarction Patients with Non-Chest Pain Complaints

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