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    Trends in door-to-balloon time and outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction: An Australian perspective

    Access Status
    Fulltext not available
    Authors
    Brennan, A.
    Andrianopoulos, N.
    Duffy, S.
    Reid, Christopher
    Clark, D.
    Loane, P.
    New, G.
    Black, A.
    Yan, B.
    Brooks, M.
    Roberts, L.
    Carroll, E.
    Lefkovits, J.
    Ajani, A.
    Date
    2014
    Type
    Journal Article
    
    Metadata
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    Citation
    Brennan, A. and Andrianopoulos, N. and Duffy, S. and Reid, C. and Clark, D. and Loane, P. and New, G. et al. 2014. Trends in door-to-balloon time and outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction: An Australian perspective. Internal Medicine Journal. 44 (5): pp. 471-477.
    Source Title
    Internal Medicine Journal
    DOI
    10.1111/imj.12405
    ISSN
    1444-0903
    School
    Department of Health Policy and Management
    URI
    http://hdl.handle.net/20.500.11937/39048
    Collection
    • Curtin Research Publications
    Abstract

    Background: Guidelines for patients with ST-elevation myocardial infarction include a door-to-balloon time (DTBT) of =90min for primary percutaneous coronary intervention. Aim: The aim of this study was to assess temporal trends (2006-2010) in DTBT and determine if a reduction in DTBT was associated with improved clinical outcomes. Methods: We compared annual median DTBT in 1926 STEMI patients undergoing primary percutaneous coronary intervention from the Melbourne Interventional Group registry. ST-elevation myocardial infarction presenting >12h and rescue percutaneous coronary intervention was excluded. Major adverse cardiac events were analysed according to DTBT (dichotomised as =90min vs >90min). A multivariable analysis for predictors of mortality (including DTBT) was performed. Results: Baseline demographics, clinical and procedural characteristics were similar in the STEMI cohort across the 5 years, apart from an increase in out-of-hospital cardiac arrest (3.6% in 2006 vs 9.4% in 2010, P < 0.0001) and cardiogenic shock (7.7-9.6%, P = 0.07). The median DTBT (interquartile range) was reduced from 95 (74-130) min in 2006 to 75 (51-100) min in 2010 (P < 0.01). In this period, the proportion of patients achieving a DTBT of =90min increased from 45% to 67% (P < 0.01). Lower mortality and major adverse cardiac event rates were observed with DTBT =90min (all P < 0.01). Multivariable analysis showed that a DTBT of =90min was associated with improved clinical outcomes at 12 months (odds ratio 0.48; 95% confidence interval 0.33-0.73, P < 0.01). Conclusion: There has been a decline in median DTBT in the Melbourne Interventional Group registry over 5 years. DTBT of =90min is associated with improved clinical outcomes at 12 months. © 2014 Royal Australasian College of Physicians.

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