Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: A meta-analysis
MetadataShow full item record
Objective: This study aims to determine the relationship between door-to-balloon delay in primary percutaneous coronary intervention and ST-elevation myocardial infarction (MI) outcomes and examine for potential effect modifiers. Methods: We conducted a systematic review and meta-analysis of prospective observational studies that have investigated the relationship of door-to-balloon delay and clinical outcomes. The main outcomes include mortality and heart failure. Results: 32 studies involving 299 320 patients contained adequate data for quantitative reporting. Patients with ST-elevation MI who experienced longer (>90 min) door-to-balloon delay had a higher risk of short-term mortality (pooled OR 1.52, 95% CI 1.40 to 1.65) and medium-term to long-term mortality (pooled OR 1.53, 95% CI 1.13 to 2.06). A non-linear time-risk relation was observed (P=0.004 for non-linearity). The association between longer door-to-balloon delay and short-term mortality differed between those presented early and late after symptom onset (Cochran's Q 3.88, P value 0.049) with a stronger relationship among those with shorter prehospital delays. Conclusion: Longer door-to-balloon delay in primary percutaneous coronary intervention for ST-elevation MI is related to higher risk of adverse outcomes. Prehospital delays modified this effect. The non-linearity of the time-risk relation might explain the lack of population effect despite an improved door-to-balloon time in the USA. Clinical trial registration PROSPERO (CRD42015026069).
Showing items related by title, author, creator and subject.
Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort studyFoo, C.Y.; Andrianopoulos, N.; Brennan, Angela; Ajani, A.; Reid, Christopher ; Duffy, S.J.; Clark, D.J.; Reidpath, Daniel; Chaiyakunapruk, N. (2019)Literature studying the door-to-balloon time-outcome relation in coronary intervention is limited by the potential of residual biases from unobserved confounders. This study re-examines the time-outcome relation with ...
Impact of door-to-balloon time on long-term mortality in high- and low-risk patients with ST-elevation myocardial infarctionYudi, M.; Ramchand, J.; Farouque, O.; Andrianopoulos, N.; Chan, W.; Duffy, S.; Lefkovits, J.; Brennan, A.; Spencer, R.; Fernando, D.; Hiew, C.; Freeman, M.; Reid, Christopher; Ajani, A.; Clark, D. (2016)© 2016Background 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 ...
Forsyth, René; Sun, Zhonghua ; Reid, C.; Moorin, R. (2020)Background Key performance indices such as door-to-balloon times have long been recognized as quality metrics in reducing time to care for patients with acute coronary syndromes (ACS). In the situation where patients do ...