Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: A meta-analysis
|dc.identifier.citation||Foo, C. and Bonsu, K. and Nallamothu, B. and Reid, C. and Dhippayom, T. and Reidpath, D. and Chaiyakunapruk, N. 2018. Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: A meta-analysis. Heart. 104 (16): pp. 1362-1369.|
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).
|dc.publisher||BMJ Publishing Group|
|dc.title||Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: A meta-analysis|
|curtin.department||School of Public Health|
|curtin.accessStatus||Fulltext not available|
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