Symptom onset-to-balloon time and mortality in the first seven years after STEMI treated with primary percutaneous
Daniela Rollando1, Enrico Puggioni, Stefano Robotti
1Department of Cardiology, Ospedali del Tigullio, Lavagna 16033, Italy.
Insights
Reducing treatment delays for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI) significantly improves long-term survival. Minimizing symptom onset-to-balloon time is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Timely intervention is critical for ST-segment elevation myocardial infarction (STEMI) management.
- Optimizing prehospital and procedural times is essential for acute myocardial infarction care.
- Limited long-term data exist on the impact of symptom onset-to-balloon time on mortality.
Purpose of the Study:
- To assess the effect of primary percutaneous coronary intervention (PPCI) treatment delay on long-term survival in STEMI patients.
- To investigate the relationship between symptom onset-to-balloon time and mortality.
- To identify predictors of treatment delay in STEMI patients.
Main Methods:
- Single-centre observational follow-up study of 790 STEMI patients undergoing PPCI.
- Evaluation of long-term survival based on treatment delay (symptom onset to reperfusion).
- Analysis of patient and system delays, and predictors of shorter treatment times.
Main Results:
- Median treatment delay was 180 minutes, with balanced patient and system delays.
- Patients with delays <180 minutes had significantly lower 1-7 year mortality rates compared to those with delays >180 minutes (HR 0.7).
- Field triage, transportation, shorter hospital distance, and male gender independently predicted shorter treatment delays.
Conclusions:
- Shorter symptom onset-to-balloon times are associated with improved long-term mortality in STEMI patients receiving PPCI.
- Minimizing all components of treatment delay is essential for optimizing patient outcomes.
- System-level interventions focusing on prehospital care and logistics can reduce treatment delays.
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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