title: Trends in door-to-balloon time and outcomes following primary percutaneous coronary intervention for ST-elevation myocardial infarction: an Australian perspective.
abstract: BACKGROUND
  Guidelines for patients with ST-elevation myocardial infarction include a door-to-balloon time (DTBT) of ≤90 min for primary percutaneous coronary intervention.
  
  
  OBJECTIVE
  The aim of this study was to assess temporal trends (2006-2010) in DTBT and determine if a reduction in DTBT was associated with improved clinical outcomes.
  
  
  METHODS
  We compared annual median DTBT in 1926 STEMI patients undergoing primary percutaneous coronary intervention from the Melbourne Interventional Group registry. ST-elevation myocardial infarction presenting >12 h and rescue percutaneous coronary intervention was excluded. Major adverse cardiac events were analysed according to DTBT (dichotomised as ≤90 min vs >90 min). A multivariable analysis for predictors of mortality (including DTBT) was performed.
  
  
  RESULTS
  Baseline demographics, clinical and procedural characteristics were similar in the STEMI cohort across the 5 years, apart from an increase in out-of-hospital cardiac arrest (3.6% in 2006 vs 9.4% in 2010, P < 0.0001) and cardiogenic shock (7.7-9.6%, P = 0.07). The median DTBT (interquartile range) was reduced from 95 (74-130) min in 2006 to 75 (51-100) min in 2010 (P < 0.01). In this period, the proportion of patients achieving a DTBT of ≤90 min increased from 45% to 67% (P < 0.01). Lower mortality and major adverse cardiac event rates were observed with DTBT ≤90 min (all P < 0.01). Multivariable analysis showed that a DTBT of ≤90 min was associated with improved clinical outcomes at 12 months (odds ratio 0.48; 95% confidence interval 0.33-0.73, P < 0.01).
  
  
  CONCLUSIONS
  There has been a decline in median DTBT in the Melbourne Interventional Group registry over 5 years. DTBT of ≤90 min is associated with improved clinical outcomes at 12 months.
authors.affiliation: Centre of Cardiovascular Research and Education in Therapeutics (CCRET), Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Cardiology, Alfred Hospital, Melbourne, Victoria, Australia.
authors.forename: A L
authors.initials: AL
authors.lastname: Brennan
authors.forename: N
authors.initials: N
authors.lastname: Andrianopoulos
authors.forename: S J
authors.initials: SJ
authors.lastname: Duffy
authors.forename: C M
authors.initials: CM
authors.lastname: Reid
authors.forename: D J
authors.initials: DJ
authors.lastname: Clark
authors.forename: P
authors.initials: P
authors.lastname: Loane
authors.forename: G
authors.initials: G
authors.lastname: New
authors.forename: A
authors.initials: A
authors.lastname: Black
authors.forename: B P
authors.initials: BP
authors.lastname: Yan
authors.forename: M
authors.initials: M
authors.lastname: Brooks
authors.forename: L
authors.initials: L
authors.lastname: Roberts
authors.forename: E A
authors.initials: EA
authors.lastname: Carroll
authors.forename: J
authors.initials: J
authors.lastname: Lefkovits
authors.forename: A E
authors.initials: AE
authors.lastname: Ajani
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000639:trends*; D003131:Combined Modality Therapy; D015897:Comorbidity; D003328:Coronary Thrombosis / Q000401:mortality / Q000601:surgery / Q000628:therapy; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012042:Registries; D016879:Salvage Therapy; D015607:Stents / Q000706:statistics & numerical data; D016019:Survival Analysis; D062606:Tertiary Care Centers / Q000706:statistics & numerical data; D017131:Thrombectomy; D013997:Time Factors; D016896:Treatment Outcome; D014739:Victoria / Q000453:epidemiology
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: ST-elevation myocardial infarction; clinical outcome; door-to-balloon time; primary percutaneous coronary intervention; trend