title: [Primary percutaneous angioplasty. An analysis of reperfusion delays, their determining factors and their prognostic implications].
abstract: OBJECTIVE
  The optimum treatment for patients with ST-segment elevation acute myocardial infraction (AMI) is primary percutaneous coronary intervention (PCI), provided that the door-to-balloon time is less than 90 min. The aims of this study were to determine actual treatment times in our patients, to investigate the effect of different factors in reducing those times, and to evaluate the impact of any delay on prognosis.
  
  
  METHODS
  The study involved patients who underwent primary or rescue PCI at our center between January 2005 and October 2007. Treatment times, clinical and angiographic characteristics, and follow-up findings at 1 and 12 months were recorded prospectively.
  
  
  RESULTS
  Overall, 389 PCIs were performed: 361 primary and 28 rescue interventions. The median total duration of ischemia was 235 [interquartile range, 170-335] min. The median door-to-balloon time was 79 [53-104] min. The door-to-balloon time was shorter when the ambulance service was able to notify the on-duty cardiologist, who alerted the interventional cardiology team. The difference was 30 [60-90] min (P< .01). Patients who arrived at the emergency department by their own means had the longest door-to-balloon time (100 min vs. 74 min; P< .01). A door-to-balloon time >120 min was associated with higher mortality at 30 days; multivariate analysis showed a clearly increasing trend.
  
  
  CONCLUSIONS
  The door-to-balloon time at our center was in line with current recommendations, with the time being markedly shorter for patients for whom the ambulance service was able to give advanced warning. A shorter time was associated with a trend towards lower 30-day mortality.
authors.affiliation: Servicio de Cardiología, Hospital Puerta de Hierro, Madrid, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Mingo
authors.forename: Javier
authors.initials: J
authors.lastname: Goicolea
authors.forename: Luis
authors.initials: L
authors.lastname: Nombela
authors.forename: Elena
authors.initials: E
authors.lastname: Sufrate
authors.forename: Ana
authors.initials: A
authors.lastname: Blasco
authors.forename: Isabel
authors.initials: I
authors.lastname: Millán
authors.forename: Raymundo
authors.initials: R
authors.lastname: Ocaranza
authors.forename: José A
authors.initials: JA
authors.lastname: Fernández-Díaz
authors.forename: Javier
authors.initials: J
authors.lastname: Ortigosa
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Romero
authors.forename: Luis
authors.initials: L
authors.lastname: Alonso-Pulpón
mesh_terms: D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000601:surgery*; D015425:Myocardial Reperfusion / Q000009:adverse effects*; D011379:Prognosis; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013997:Time Factors; D014187:Transportation of Patients