Impact of door-to-balloon time on long-term mortality in high- and low-risk patients with ST-elevation myocardial infarction

Matias B. Yudi, Jay Ramchand, Omar Farouque, Nick Andrianopoulos, William Chan, Stephen J. Duffy, Jeffrey Lefkovits, Angela Brennan, Ryan Spencer, Dharsh Fernando, Chin Hiew, Melanie Freeman, Christopher M. Reid, Andrew E. Ajani, David J. Clark, Melbourne Interventional Group

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Abstract

Background Door-to-balloon time (DTBT) less than 90 min remains the benchmark of timely reperfusion in ST-elevation myocardial infarction (STEMI). The relative long-term benefit of timely reperfusion in STEMI patients with differing risk profiles is less certain. Thus, we aimed to assess the impact of DTBT on long-term mortality in high- and low-risk STEMI patients. Method We analysed baseline clinical and procedural characteristics of 2539 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) from the Melbourne Interventional Group registry from 2004 to 2012. Patients were classified high risk (HR-STEMI) if they presented with cardiogenic shock, out-of-hospital cardiac arrest (OHCA) or Killip class ≥ 2; or low-risk (LR-STEMI) if there were no high-risk features. We then stratified high- and low-risk patients by DTBT (≤ 90 min vs. > 90 min) and assessed long-term mortality. Result Of the 2539 patients, 395 (16%) met the high-risk criteria. A DTBT ≤ 90 min was achieved in 43% of HR-STEMI patients and in 55% of LR-STEMI patients. Patients in the HR-STEMI compared to LR-STEMI cohort had higher in-hospital (31% vs. 1%, p < 0.01) and long-term mortality (37% vs. 7%, p < 0.01). A DTBT ≤ 90 min was associated with significant improvements in short- and long-term mortality in both groups. A DTBT ≤ 90 min was an independent multivariate predictor of long-term survival in LR-STEMI (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.3–0.9, p = 0.02) but not in HR-STEMI (HR 0.7, 95% CI 0.5–1.1, p = 0.11). Conclusion A DTBT ≤ 90 min was associated with improved short- and long-term outcomes in high- and low-risk STEMI patients. However, it was only an independent predictor of long-term survival in LR-STEMI patients.

Original languageEnglish
Pages (from-to)72-78
Number of pages7
JournalInternational Journal of Cardiology
Volume224
DOIs
Publication statusPublished - 1 Dec 2016

Keywords

  • Cardiogenic shock
  • Door-to-balloon-time
  • Out-of-hospital cardiac arrest
  • Percutaneous coronary intervention
  • Risk assessment
  • STEMI

Cite this

Yudi, Matias B. ; Ramchand, Jay ; Farouque, Omar ; Andrianopoulos, Nick ; Chan, William ; Duffy, Stephen J. ; Lefkovits, Jeffrey ; Brennan, Angela ; Spencer, Ryan ; Fernando, Dharsh ; Hiew, Chin ; Freeman, Melanie ; Reid, Christopher M. ; Ajani, Andrew E. ; Clark, David J. ; Melbourne Interventional Group. / Impact of door-to-balloon time on long-term mortality in high- and low-risk patients with ST-elevation myocardial infarction. In: International Journal of Cardiology. 2016 ; Vol. 224. pp. 72-78.
@article{8698973312784145b66f4fde278b762a,
title = "Impact of door-to-balloon time on long-term mortality in high- and low-risk patients with ST-elevation myocardial infarction",
abstract = "Background Door-to-balloon time (DTBT) less than 90 min remains the benchmark of timely reperfusion in ST-elevation myocardial infarction (STEMI). The relative long-term benefit of timely reperfusion in STEMI patients with differing risk profiles is less certain. Thus, we aimed to assess the impact of DTBT on long-term mortality in high- and low-risk STEMI patients. Method We analysed baseline clinical and procedural characteristics of 2539 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) from the Melbourne Interventional Group registry from 2004 to 2012. Patients were classified high risk (HR-STEMI) if they presented with cardiogenic shock, out-of-hospital cardiac arrest (OHCA) or Killip class ≥ 2; or low-risk (LR-STEMI) if there were no high-risk features. We then stratified high- and low-risk patients by DTBT (≤ 90 min vs. > 90 min) and assessed long-term mortality. Result Of the 2539 patients, 395 (16{\%}) met the high-risk criteria. A DTBT ≤ 90 min was achieved in 43{\%} of HR-STEMI patients and in 55{\%} of LR-STEMI patients. Patients in the HR-STEMI compared to LR-STEMI cohort had higher in-hospital (31{\%} vs. 1{\%}, p < 0.01) and long-term mortality (37{\%} vs. 7{\%}, p < 0.01). A DTBT ≤ 90 min was associated with significant improvements in short- and long-term mortality in both groups. A DTBT ≤ 90 min was an independent multivariate predictor of long-term survival in LR-STEMI (hazard ratio [HR] 0.5, 95{\%} confidence interval [CI] 0.3–0.9, p = 0.02) but not in HR-STEMI (HR 0.7, 95{\%} CI 0.5–1.1, p = 0.11). Conclusion A DTBT ≤ 90 min was associated with improved short- and long-term outcomes in high- and low-risk STEMI patients. However, it was only an independent predictor of long-term survival in LR-STEMI patients.",
keywords = "Cardiogenic shock, Door-to-balloon-time, Out-of-hospital cardiac arrest, Percutaneous coronary intervention, Risk assessment, STEMI",
author = "Yudi, {Matias B.} and Jay Ramchand and Omar Farouque and Nick Andrianopoulos and William Chan and Duffy, {Stephen J.} and Jeffrey Lefkovits and Angela Brennan and Ryan Spencer and Dharsh Fernando and Chin Hiew and Melanie Freeman and Reid, {Christopher M.} and Ajani, {Andrew E.} and Clark, {David J.} and {Melbourne Interventional Group}",
year = "2016",
month = "12",
day = "1",
doi = "10.1016/j.ijcard.2016.09.003",
language = "English",
volume = "224",
pages = "72--78",
journal = "International Journal of Cardiology",
issn = "0167-5273",
publisher = "Elsevier",

}

Impact of door-to-balloon time on long-term mortality in high- and low-risk patients with ST-elevation myocardial infarction. / Yudi, Matias B.; Ramchand, Jay; Farouque, Omar; Andrianopoulos, Nick; Chan, William; Duffy, Stephen J.; Lefkovits, Jeffrey; Brennan, Angela; Spencer, Ryan; Fernando, Dharsh; Hiew, Chin; Freeman, Melanie; Reid, Christopher M.; Ajani, Andrew E.; Clark, David J.; Melbourne Interventional Group.

In: International Journal of Cardiology, Vol. 224, 01.12.2016, p. 72-78.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Impact of door-to-balloon time on long-term mortality in high- and low-risk patients with ST-elevation myocardial infarction

AU - Yudi, Matias B.

AU - Ramchand, Jay

AU - Farouque, Omar

AU - Andrianopoulos, Nick

AU - Chan, William

AU - Duffy, Stephen J.

AU - Lefkovits, Jeffrey

AU - Brennan, Angela

AU - Spencer, Ryan

AU - Fernando, Dharsh

AU - Hiew, Chin

AU - Freeman, Melanie

AU - Reid, Christopher M.

AU - Ajani, Andrew E.

AU - Clark, David J.

AU - Melbourne Interventional Group

PY - 2016/12/1

Y1 - 2016/12/1

N2 - Background Door-to-balloon time (DTBT) less than 90 min remains the benchmark of timely reperfusion in ST-elevation myocardial infarction (STEMI). The relative long-term benefit of timely reperfusion in STEMI patients with differing risk profiles is less certain. Thus, we aimed to assess the impact of DTBT on long-term mortality in high- and low-risk STEMI patients. Method We analysed baseline clinical and procedural characteristics of 2539 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) from the Melbourne Interventional Group registry from 2004 to 2012. Patients were classified high risk (HR-STEMI) if they presented with cardiogenic shock, out-of-hospital cardiac arrest (OHCA) or Killip class ≥ 2; or low-risk (LR-STEMI) if there were no high-risk features. We then stratified high- and low-risk patients by DTBT (≤ 90 min vs. > 90 min) and assessed long-term mortality. Result Of the 2539 patients, 395 (16%) met the high-risk criteria. A DTBT ≤ 90 min was achieved in 43% of HR-STEMI patients and in 55% of LR-STEMI patients. Patients in the HR-STEMI compared to LR-STEMI cohort had higher in-hospital (31% vs. 1%, p < 0.01) and long-term mortality (37% vs. 7%, p < 0.01). A DTBT ≤ 90 min was associated with significant improvements in short- and long-term mortality in both groups. A DTBT ≤ 90 min was an independent multivariate predictor of long-term survival in LR-STEMI (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.3–0.9, p = 0.02) but not in HR-STEMI (HR 0.7, 95% CI 0.5–1.1, p = 0.11). Conclusion A DTBT ≤ 90 min was associated with improved short- and long-term outcomes in high- and low-risk STEMI patients. However, it was only an independent predictor of long-term survival in LR-STEMI patients.

AB - Background Door-to-balloon time (DTBT) less than 90 min remains the benchmark of timely reperfusion in ST-elevation myocardial infarction (STEMI). The relative long-term benefit of timely reperfusion in STEMI patients with differing risk profiles is less certain. Thus, we aimed to assess the impact of DTBT on long-term mortality in high- and low-risk STEMI patients. Method We analysed baseline clinical and procedural characteristics of 2539 consecutive STEMI patients who underwent primary percutaneous coronary intervention (PCI) from the Melbourne Interventional Group registry from 2004 to 2012. Patients were classified high risk (HR-STEMI) if they presented with cardiogenic shock, out-of-hospital cardiac arrest (OHCA) or Killip class ≥ 2; or low-risk (LR-STEMI) if there were no high-risk features. We then stratified high- and low-risk patients by DTBT (≤ 90 min vs. > 90 min) and assessed long-term mortality. Result Of the 2539 patients, 395 (16%) met the high-risk criteria. A DTBT ≤ 90 min was achieved in 43% of HR-STEMI patients and in 55% of LR-STEMI patients. Patients in the HR-STEMI compared to LR-STEMI cohort had higher in-hospital (31% vs. 1%, p < 0.01) and long-term mortality (37% vs. 7%, p < 0.01). A DTBT ≤ 90 min was associated with significant improvements in short- and long-term mortality in both groups. A DTBT ≤ 90 min was an independent multivariate predictor of long-term survival in LR-STEMI (hazard ratio [HR] 0.5, 95% confidence interval [CI] 0.3–0.9, p = 0.02) but not in HR-STEMI (HR 0.7, 95% CI 0.5–1.1, p = 0.11). Conclusion A DTBT ≤ 90 min was associated with improved short- and long-term outcomes in high- and low-risk STEMI patients. However, it was only an independent predictor of long-term survival in LR-STEMI patients.

KW - Cardiogenic shock

KW - Door-to-balloon-time

KW - Out-of-hospital cardiac arrest

KW - Percutaneous coronary intervention

KW - Risk assessment

KW - STEMI

UR - http://www.scopus.com/inward/record.url?scp=84986586453&partnerID=8YFLogxK

U2 - 10.1016/j.ijcard.2016.09.003

DO - 10.1016/j.ijcard.2016.09.003

M3 - Article

VL - 224

SP - 72

EP - 78

JO - International Journal of Cardiology

JF - International Journal of Cardiology

SN - 0167-5273

ER -