Contact-to-balloon time <90 min reduced in-hospital mortality, with the greatest benefit in STEMI patients presenting within 1 hour of symptom onset (OR 0.27; 95% CI 0.23-0.31; p<0.0001).
Cohort (n=20,005)
Does timely reperfusion with contact-to-balloon time <90 min reduce in-hospital mortality in STEMI patients across different symptom-onset-to-first-medical-contact (S2C) times?
Timely reperfusion with contact-to-balloon time <90 min provides the greatest survival benefit in STEMI patients presenting within 1 hour of symptom onset, though benefit remains significant for presentations up to 24 hours.
Odds Ratio: 0.27 (95% CI 0.23–0.31)
p-value: p=<0.0001
BACKGROUND: In patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion. AIMS: To assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times. METHODS: A total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included. RESULTS: There were 1554 deaths (7.8%) with a J-shaped relationship between mortality and S2C time. Mortality was 10.0% in patients presenting within 1 hour, and 4.9%, 6.0% and 7.3% in patient groups with longer S2C intervals of 1-2 hours, 2-6 hours and 6-24 hours, respectively. Patients with a short S2C interval of less than 1 hour (S2C<60 min) had the highest survival benefit from timely reperfusion with PCI within 90 min (OR 0.27, 95% CI 0.23 to 0.31, p<0.0001) as compared with the three groups with longer S2C intervals of 1 hour<S2C≤2 hours (OR 0.44, 95% CI 0.33 to 0.59, p<0.0001), 2 hours<S2C≤6 hours (OR 0.49, 95% CI 0.38 to 0.64, p<0.0001) and 6 hours<S2C≤24 hours (OR 0.42, 95% CI 0.30 to 0.58, p<0.0001). CONCLUSIONS: Timely reperfusion with a contact-to-balloon time of less than 90 min is most effective in patients presenting with short S2C intervals of less than 1 hour, but has also beneficial effects in patients with S2C intervals of up to 24 hours. TRIAL REGISTRATION NUMBER: NCT00794001.
Scholz et al. (Sat,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=20,005). Contact-to-balloon time <90 min vs. Contact-to-balloon time ≥90 min was evaluated on In-hospital mortality (OR 0.27, 95% CI 0.23-0.31, p=<0.0001). Contact-to-balloon time <90 min reduced in-hospital mortality, with the greatest benefit in STEMI patients presenting within 1 hour of symptom onset (OR 0.27; 95% CI 0.23-0.31; p<0.0001).