title: Symptom-to-Balloon Time is a Strong Predictor of Adverse Events Following Primary Percutaneous Coronary Intervention: Results From the Australian Capital Territory PCI Registry.
abstract: BACKGROUND
  Notwithstanding improvements in door-to-balloon time, adverse event rates after primary PCI have remained steady. We analysed the effect of symptom-to-balloon (STB) time, a reflection of total ischaemic time, on major adverse cardiovascular events (MACE) and explored predictors of prolonged STB time.
  
  
  METHODS
  The study population included 1002 consecutive patients (22.4% women) with a mean age of 62.3±13.2 years, who underwent primary PCI during 2008-2014. Groups were compared for STB ≤ and >240min. Primary endpoint was one-year MACE, a composite of death, reinfarction, stent thrombosis or target vessel revascularisation.
  
  
  RESULTS
  Symptom-to-balloon time was available in 893 patients of which 588 (65.8%) had STB ≤240min and 305 (34.2%) had STB >240min. The incidence of one-year MACE increased significantly in a stepwise manner with increasing STB time (p for trend=0.003). Symptom-to-balloon time was an independent predictor of one-year MACE along with age >70 years, final TIMI flow <3, three vessel disease, cardiogenic shock and out-of-hospital cardiac arrest. We also performed a multivariate analysis to determine predictors of delayed treatment. Predictors of STB time >240min were age >70 years, female gender, diabetes, absence of prehospital catheter laboratory activation and presentation to a non-PCI centre.
  
  
  CONCLUSIONS
  Incidence of MACE was strongly correlated with STB time and STB time was an independent predictor of MACE. We have identified specific subgroups with prolonged STB times (age >70, female gender, diabetes, absence of prehospital activation and presentation to a non-PCI centre). This information should inform future studies and strategies to minimise delays in these subgroups for improved outcomes.
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Jaya
authors.initials: J
authors.lastname: Chandrasekhar
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Marley
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Allada
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Darryl
authors.initials: D
authors.lastname: McGill
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Simon
authors.initials: S
authors.lastname: O'Connor
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Moyazur
authors.initials: M
authors.lastname: Rahman
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Ren
authors.initials: R
authors.lastname: Tan
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia.
authors.forename: Ata Doost
authors.initials: AD
authors.lastname: Hosseiny
authors.affiliation: Centre for Biostatistics and Epidemiology, The Canberra Hospital, Canberra, ACT, Australia; College of Medicine, Biology and Ecology, Australian National University, Canberra, ACT, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Shadbolt
authors.affiliation: Department of Cardiology, The Canberra Hospital, Canberra, ACT, Australia; College of Medicine, Biology and Ecology, Australian National University, Canberra, ACT, Australia. Electronic address: afarshid@tpg.com.au.
authors.forename: Ahmad
authors.initials: A
authors.lastname: Farshid
mesh_terms: D000368:Aged; D001315:Australia; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000209:etiology / Q000401:mortality*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011183:Postoperative Complications / Q000401:mortality*; D012042:Registries; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000601:surgery*; D012770:Shock, Cardiogenic / Q000209:etiology / Q000401:mortality*; D013997:Time Factors
keywords: Door-to-balloon time; Major adverse cardiovascular events; Primary PCI; ST elevation myocardial infarction; Symptom-to-balloon time; Time to treatment