Impact of call-to-balloon time on 30-day mortality in contemporary practice
Richard W Varcoe1, Tim C Clayton2, Huon H Gray3
1Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
Insights
Treatment delays in primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI) increase mortality risk. Minimizing call-to-balloon (CTB) time is crucial, especially for high-risk patients, even within national reperfusion services.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Previous studies on treatment delay in ST-elevation myocardial infarction (STEMI) often excluded patients receiving primary percutaneous coronary intervention (PPCI) within systematic reperfusion services.
- Understanding the impact of call-to-balloon (CTB) time on outcomes in contemporary PPCI settings is essential.
Purpose of the Study:
- To determine the association between call-to-balloon (CTB) time and 30-day mortality in patients undergoing primary percutaneous coronary intervention (PPCI) for STEMI.
- To evaluate CTB time within a national reperfusion service framework.
Main Methods:
- Analysis of 16,907 consecutive STEMI patients treated with PPCI in England and Wales in 2011, with CTB times ≤6 hours.
- Statistical analysis to assess the independent association of CTB time with 30-day mortality, considering patient risk profiles.
Main Results:
- Median CTB time was 111 minutes; 80.9% of patients were treated within 150 minutes.
- Out-of-hours calls and inter-hospital transfers significantly increased CTB times.
- CTB time was independently associated with 30-day mortality (HR 1.95 for CTB >180-240 min vs ≤90 min), with a greater impact in high-risk patients.
Conclusions:
- Call-to-balloon (CTB) time remains a critical metric for assessing primary percutaneous coronary intervention (PPCI) service performance.
- Efforts to minimize reperfusion delays are vital, even within established national PPCI services.
- Patient risk stratification influences the impact of CTB time on mortality outcomes.
Objective:
Studies reporting an association between treatment delay and outcome for patients with ST segment elevation myocardial infarction (STEMI) have generally not included patients treated by a primary percutaneous coronary intervention (PPCI) service that systematically delivers reperfusion therapy to all eligible patients. We set out to determine the association of call-to-balloon (CTB) time with 30-day mortality after PPCI in a contemporary series of patients treated within a national reperfusion service.
Methods:
We analysed data on 16 907 consecutive patients with STEMI treated by PPCI in England and Wales in 2011 with CTB time of ≤6 hours.
Results:
The median CTB and door-to-balloon times were 111 and 41 min, respectively, with 80.9% of patients treated within 150 min of the call for help. An out-of-hours call time (58.2% of patients) was associated with a 10 min increase in CTB time, whereas inter-hospital transfer for PPCI (18.5% of patients) was associated with a 49 min increase in CTB time. CTB time was independently associated with 30-day mortality (p<0.0001) with a HR of 1.95 (95% CI 1.54 to 2.47) for a CTB time of >180-240 min compared with ≤90 min. The relationship between CTB time and 30-day mortality was influenced by patient risk profile with a greater absolute impact of increasing CTB time on mortality in high-risk patients.
Conclusion:
CTB time is a useful metric to assess the overall performance of a PPCI service. Delays to reperfusion remain important even in the era of organised national PPCI services with rapid treatment times and efforts should continue to minimise treatment delays.
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