title: Symptom onset-to-balloon time and mortality in the first seven years after STEMI treated with primary percutaneous coronary intervention.
abstract: OBJECTIVE
  To evaluate the consequence of treatment delay of primary percutaneous coronary intervention (PPCI) on long-term survival.
  
  
  BACKGROUND
  Network organisation based on early recognition, shortening prehospital time delays and procedural delays is the cornerstone of optimal clinical results in the acute phase of ST-segment elevation myocardial infarction (STEMI). Nevertheless, the evidence of a relationship between symptom onset-to-balloon time and mortality is weak, and few long-term data are available. SETTING AND MEASURES: In this single-centre observational follow-up study, we evaluated the long-term survival of 790 consecutive STEMI patients (mean age 68 ± 13 years; 73% males) undergoing PPCI ≤ 12 h from symptom onset, or 12-36 h in the case of persistence of symptoms or hemodynamic instability.
  
  
  RESULTS
  The median (IQR) treatment delay, defined as the time from symptom onset to reperfusion, was 180 min (120;310), fairly balanced between patient delay (80 min (40;140)) and system delay (80 min (60-114)). Patients with a treatment delay <180 min displayed lower mortality at 1, 3, 5 and 7 years (12%, 17%, 22% and 26%, respectively) than those with a treatment delay >180 min (15%, 24%, 28% and 37%, respectively). The HR was 0.7 (95% CI 0.5 to 0.9). On univariate and stepwise multiple regression analysis, field triage and transportation (p=0.0001), shorter distance from hospital (p=0.02) and male gender (p=0.02), but not clinical variables, were independent predictors of shorter treatment delay.
  
  
  CONCLUSIONS
  Shorter symptom onset-to-balloon time predicts long-term lower mortality in STEMI patients treated with PPCI. Our findings emphasise the need to minimise any component of treatment delay.
authors.affiliation: Department of Cardiology, Ospedali del Tigullio, Lavagna 16033, Italy.
authors.forename: Daniela
authors.initials: D
authors.lastname: Rollando
authors.forename: Enrico
authors.initials: E
authors.lastname: Puggioni
authors.forename: Stefano
authors.initials: S
authors.lastname: Robotti
authors.forename: Angelo
authors.initials: A
authors.lastname: De Lisi
authors.forename: Maura
authors.initials: M
authors.lastname: Ferrari Bravo
authors.forename: Adriana
authors.initials: A
authors.lastname: Vardanega
authors.forename: Ivo
authors.initials: I
authors.lastname: Pattaro
authors.forename: Federica
authors.initials: F
authors.lastname: De Benedetti
authors.forename: Michele
authors.initials: M
authors.lastname: Brignole
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000601:surgery; D062645:Percutaneous Coronary Intervention / Q000401:mortality*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014218:Triage