Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study

• DOI: 10.1136/bmj.e3257
• Publication Date: 2012-05-23T17:30:22Z
• Authors: H. Shiomi; Y. Nakagawa; T. Morimoto; Y. Furukawa; A. Nakano; S. Shirai; R. Taniguchi; K. Yamaji; K. Nagao; T. Suyama; H. Mitsuoka; M. Araki; H. Takashima; T. Mizoguchi; H. Eisawa; S. Sugiyama; T. Kimura
• Keywords: Clinical endpoint; Door-to-balloon

<b>Objective</b> To evaluate the relation of symptom onset to balloon time and door with long term clinical outcome in patients ST segment elevation myocardial infarction (STEMI) having primary percutaneous coronary intervention. <b>Design</b> Observation large cohort acute infarction. <b>Setting</b> 26 tertiary hospitals Japan. <b>Participants</b> 3391 STEMI who had intervention within 24 hours onset. <b>Main measures</b> Composite death congestive heart failure, compared by time. <b>Results</b> Compared an greater than 3 hours, a less was associated lower incidence composite failure (13.5% (123/964) <i>v</i> 19.2% (429/2427), P&lt;0.001; relative risk reduction 29.7%). After adjustment for confounders, short independently endpoint (adjusted hazard ratio 0.70, 95% confidence interval 0.56 0.88; P=0.002). However, no significant difference found between two groups (≤90 minutes) (&gt;90 (16.7% (270/1671) 18.4% (282/1720), P=0.54; 9.2%). seen ratio: 0.98, 0.78 1.24: P=0.87). A 90 minutes presented 2 (11.9% (74/883) 18.1% (147/655), P=0.01; 34.3%) but not later (19.7% (196/788) 18.7% (135/1065), P=0.44; −5.3%). Short early presentation 0.58, 0.38 0.87; P=0.009) delayed (1.57, 1.12 2.18; P=0.008). interaction (interaction P=0.01). <b>Conclusions</b> better year intervention, whereas benefit limited early. Efforts minimise time, including patient related delay, should be recommended improve patients.