Author + information
- Peter Moore1,
- Yash Singbal2,
- Jillian Milne3,
- Thomas Rosenfeld4,
- Deepu Balakrishnan5,
- Katherine Pemberton6,
- Emma Bosley6 and
- Richard Lim2
- 1Royal Jubilee Hospital, Victoria, British Columbia, Canada
- 2Princess Alexandra Hospital & University of Queensland, Brisbane, Queensland, Australia
- 3Queensland Cardiac Outcomes Registry, Queensland Health, Brisbane, Queensland, Australia
- 4University of Queensland, Brisbane, Queensland, Australia
- 5Princess Alexandra Hospital, Brisbane, Queensland, Australia
- 6Queensland Ambulance Service, Brisbane, Queensland, Australia
The greater the delay to reperfusion with primary PCI (PPCI) for ST elevation myocardial infarction (STEMI), the higher the mortality. The traditional prognostic yardstick of 90 minutes (min) was based on analysis of door-to-balloon (D2B) time. Although the evolution of emergency care systems has led to first medical contact (FMC)-to-first device time (FDT) superceding D2B time as the measure of efficiency of a contemporary PPCI service, it is not clear what constitutes a reasonably achievable target with prognostic implications. We therefore compared 12-month mortality for two time intervals for FMC-to-FDT.
We analysed 474 patients undergoing PPCI within 12 hours of symptom onset between 2012 and 2015 at our tertiary center. FMC was defined as the first ECG diagnostic of STEMI. All-cause 12-month mortality was compared between FMC-to-FDT cutpoints of the traditional 90 and the more realistic 120 min.
One-hundred and five patients (22.2%) had an FMC-FDT of <90 min, 255 patients (53.8%) an FMC-FDT <120 min. Mortality was associated with an FMC-FDT cutpoint of 120 min, but not 90 min (Table 1).
This real-world PPCI analysis reflecting contemporary practice suggests a target of 120 min for FMC to FDT is a stronger prognostic discriminator in STEMI than a target of 90 min.
CORONARY: PCI Outcomes