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Title: Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study.
Austin Authors: Foo, Chee Yoong;Andrianopoulos, Nick;Brennan, Angela;Ajani, Andrew;Reid, Christopher M;Duffy, Stephen J;Clark, David J ;Reidpath, Daniel D;Chaiyakunapruk, Nathorn
Affiliation: Department of Cardiology, Austin Health, Heidelberg, Victoria, Australia
Centre of Cardiovascular Research & Education in Therapeutics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
Department of Cardiology, Alfred Hospital, Melbourne, Australia
Department of Cardiology, Royal Melbourne Hospital, Melbourne, Australia
Department of Medicine, University of Melbourne, Melbourne, Australia
Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
School of Public Health, Curtin University, Perth, WA, Australia
Molecular, Genetic & Population Health Sciences, University of Edinburgh, Edinburgh, UK
National Clinical Research Centre, Kuala Lumpur, Malaysia
School of Pharmacy, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Bandar Sunway, Selangor, Malaysia
Department of Pharmacotherapy, College of Pharmacy, The University of Utah, Salt Lake City, UT, USA
Issue Date: 27-Dec-2019 2019-12-27
Publication information: Scientific Reports 2019; 9(1): 19978
Abstract: Literature studying the door-to-balloon time-outcome relation in coronary intervention is limited by the potential of residual biases from unobserved confounders. This study re-examines the time-outcome relation with further consideration of the unobserved factors and reports the population average effect. Adults with ST-elevation myocardial infarction admitted to one of the six registry participating hospitals in Australia were included in this study. The exposure variable was patient-level door-to-balloon time. Primary outcomes assessed included in-hospital and 30 days mortality. 4343 patients fulfilled the study criteria. 38.0% (1651) experienced a door-to-balloon delay of >90 minutes. The absolute risk differences for in-hospital and 30-day deaths between the two exposure subgroups with balanced covariates were 2.81 (95% CI 1.04, 4.58) and 3.37 (95% CI 1.49, 5.26) per 100 population. When unmeasured factors were taken into consideration, the risk difference were 20.7 (95% CI -2.6, 44.0) and 22.6 (95% CI -1.7, 47.0) per 100 population. Despite further adjustment of the observed and unobserved factors, this study suggests a directionally consistent linkage between longer door-to-balloon delay and higher risk of adverse outcomes at the population level. Greater uncertainties were observed when unmeasured factors were taken into consideration.
DOI: 10.1038/s41598-019-56353-7
ORCID: 0000-0002-1833-4290
PubMed URL: 31882674
Type: Journal Article
Appears in Collections:Journal articles

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