Longer door-to-balloon delay (>90 min) during primary percutaneous coronary intervention for STEMI was associated with a higher risk of short-term mortality (OR 1.52; 95% CI 1.40-1.65).
Meta-Analysis (n=299,320)
Does longer door-to-balloon delay (>90 min) increase mortality and heart failure in patients with ST-elevation MI undergoing primary percutaneous coronary intervention?
Longer door-to-balloon delay (>90 min) in primary PCI for STEMI is associated with significantly higher short- and long-term mortality, with a stronger effect in patients presenting early after symptom onset.
Effect estimate: OR 1.52 (95% CI 1.40-1.65)
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).
Foo et al. (Mon,) conducted a meta-analysis in ST-elevation myocardial infarction (n=299,320). Longer (>90 min) door-to-balloon delay vs. Shorter door-to-balloon delay was evaluated on Short-term mortality (OR 1.52, 95% CI 1.40-1.65). Longer door-to-balloon delay (>90 min) during primary percutaneous coronary intervention for STEMI was associated with a higher risk of short-term mortality (OR 1.52; 95% CI 1.40-1.65).
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