title: Impact of call-to-balloon time on 30-day mortality in contemporary practice.
abstract: Studies reporting an association between treatment delay and outcome for patients with ST segment elevation myocardial infarction (STEMI) have generally not included patients treated by a primary percutaneous coronary intervention (PPCI) service that systematically delivers reperfusion therapy to all eligible patients. We set out to determine the association of call-to-balloon (CTB) time with 30-day mortality after PPCI in a contemporary series of patients treated within a national reperfusion service.
  
  
  
  We analysed data on 16 907 consecutive patients with STEMI treated by PPCI in England and Wales in 2011 with CTB time of ≤6 hours.
  
  
  
  The median CTB and door-to-balloon times were 111 and 41 min, respectively, with 80.9% of patients treated within 150 min of the call for help. An out-of-hours call time (58.2% of patients) was associated with a 10 min increase in CTB time, whereas inter-hospital transfer for PPCI (18.5% of patients) was associated with a 49 min increase in CTB time. CTB time was independently associated with 30-day mortality (p<0.0001) with a HR of 1.95 (95% CI 1.54 to 2.47) for a CTB time of >180-240 min compared with ≤90 min. The relationship between CTB time and 30-day mortality was influenced by patient risk profile with a greater absolute impact of increasing CTB time on mortality in high-risk patients.
  
  
  
  CTB time is a useful metric to assess the overall performance of a PPCI service. Delays to reperfusion remain important even in the era of organised national PPCI services with rapid treatment times and efforts should continue to minimise treatment delays.
authors.affiliation: Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Varcoe
authors.affiliation: London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Tim C
authors.initials: TC
authors.lastname: Clayton
authors.affiliation: Wessex Cardiac Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
authors.forename: Huon H
authors.initials: HH
authors.lastname: Gray
authors.affiliation: The James Cook University Hospital, Middlesbrough, UK.
authors.forename: Mark A
authors.initials: MA
authors.lastname: de Belder
authors.affiliation: Queen Elizabeth Hospital, University Hospital Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: Peter F
authors.initials: PF
authors.lastname: Ludman
authors.affiliation: Trent Cardiac Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Henderson
mesh_terms: D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D055502:Secondary Prevention / Q000458:organization & administration; D017678:Sex Distribution; D013222:State Medicine / Q000458:organization & administration; D013997:Time Factors; D014852:Wales / Q000453:epidemiology