Abstract 1754: Influence of Prehospital Delay on Door to Balloon Time and Impact on Inhospital Mortality in Patients with Acute STEMI Treated with Primary PCI
Backgroud and Aim: The purpose of this analysis was to evaluate if prolonged prehospital delay (phd) influences door to balloon (dtb) times and inhospital mortality in the Vienna STEMI registry.
Patients and Methods: In this registry 631 consecutive patients (pts) with acute STEMI of < 12 hours (h) duration underwent primary PCI (PPCI). Phd was calculated as the time from symptom onset to arrival at hospital and dtb time was calculated as the time from arrival at hospital to 1st balloon inflation. According to the median phd of 2 hours (h) pts where devided into 2 different groups, with phd of ≤ 2h and > 2h, respectively.
Results: Pts with phd of ≤ 2 h had significantly shorter dtb times than patients with phd of > 2 h (p = 0,021). In an univariate logistic regression for prediction of inhospital mortality, dtb time was a significant predictor of death in the phd ≤ 2 h group (p = 0,001) but not in the phd > 2 h group (p = 0,256). In a multivariate analysis including age, shock at presentation, gender, infarct location and dtb time, predictors of mortality in the phd ≤ 2 h were age (p < 0,001; OR 1,078), shock (p < 0,001; OR 37,123) and dtb time (p = 0,088; OR 1,007), while in the phd >2 h group predictors were age (p < 0,001; OR 1,304) shock (p < 0,001; OR 1068,072) and infarct location (p < 0,068; OR 0,198) but not dtb time (p = 0,951; OR 1).
Conclusion: In this registry pts with shorter phd had a significant benefit of short dtb in terms of inhospital mortality. On the other hand in pts with prolonged phd additional loss of time for PPCI did not further influence inhospital mortality. Accordingly, in pts with short phd (≤ 2 h) time from 1st medical contact to PPCI is crucial, and should be kept a short as possible.