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May 23, 2012BMJOpen Access

An onset to balloon time of <3 hours was associated with a lower risk of death and congestive heart failure compared to >3 hours (adjusted HR 0.70; 95% CI 0.56-0.88; P=0.002).

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Why the study?

Does short onset to balloon time or short door to balloon time reduce the composite of death and congestive heart failure in patients with STEMI undergoing primary PCI?

Population

3,391 patients with ST segment elevation myocardial infarction who had primary percutaneous coronary…

Comparison

Short onset to balloon time and short door to… vs Long onset to balloon time and long door to…

Design

Cohort

Follow-up

3 years

Key result

An onset to balloon time of <3 hours was associated with a lower risk of death and congestive heart failure compared to >3 hours (adjusted HR 0.70; 95% CI 0.56-0.88; P=0.002).

Authors

HSHiroki ShiomiYNYoshihisa NakagawaTMTakeshi Morimoto

Discussion

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Overview

Supports minimizing total ischemic time in STEMI; extends prior evidence but leaves door-to-balloon impact open in observational data.

Study Design

Type

Observational (n=3,391)

Multicenter

Yes

Structured PICO

Does short onset to balloon time or short door to balloon time reduce the composite of death and congestive heart failure in patients with STEMI undergoing primary PCI?

P
Population
3,391 patients with STEMI who underwent primary percutaneous coronary intervention within 24 hours of symptom onset, followed for 3 years.
E
Exposure
Short onset to balloon time (<3 hours) and short door to balloon time (≤90 minutes) during primary percutaneous coronary intervention
C
Comparator
Long onset to balloon time (>3 hours) and long door to balloon time (>90 minutes)
O
Outcome
Composite of death and congestive heart failure at 3 yearscomposite

Main Result

Hazard Ratio: 0.7 (95% CI 0.56–0.88)

Absolute Event Rate: 13.5% vs 19.2%

p-value: p=0.002

Minimizing total ischemic time (onset to balloon) is critical for long-term outcomes in STEMI, as the benefit of rapid door-to-balloon times is primarily seen in patients who present early after symptom onset.

Cite This Study

Shiomi et al. (2012) conducted an observational in ST segment elevation myocardial infarction (STEMI) (n=3,391). Onset to balloon time < 3 hours vs. Onset to balloon time > 3 hours was evaluated on Composite of death and congestive heart failure (adjusted HR 0.70, 95% CI 0.56-0.88, p=0.002). An onset to balloon time of <3 hours was associated with a lower risk of death and congestive heart failure compared to >3 hours (adjusted HR 0.70; 95% CI 0.56-0.88; P=0.002).

synapsesocial.com/papers/6a82e3e1ca0a238f9c75b877https://doi.org/10.1136/bmj.e3257
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