BackgroundGuidelines for patients with ST-elevation myocardial infarction include a door-to-balloon time (DTBT) of 90min for primary percutaneous coronary intervention.AimThe aim of this study was to assess temporal trends (2006-2010) in DTBT and determine if a reduction in DTBT was associated with improved clinical outcomes.MethodsWe compared annual median DTBT in 1926 STEMI patients undergoing primary percutaneous coronary intervention from the Melbourne Interventional Group registry. ST-elevation myocardial infarction presenting >12h and rescue percutaneous coronary intervention was excluded. Major adverse cardiac events were analysed according to DTBT (dichotomised as 90min vs >90min). A multivariable analysis for predictors of mortality (including DTBT) was performed.ResultsBaseline demographics, clinical and procedural characteristics were similar in the STEMI cohort across the 5 years, apart from an increase in out-of-hospital cardiac arrest (3.6% in 2006 vs 9.4% in 2010, P < 0.0001) and cardiogenic shock (7.7-9.6%, P = 0.07). The median DTBT (interquartile range) was reduced from 95 (74-130) min in 2006 to 75 (51-100) min in 2010 (P < 0.01). In this period, the proportion of patients achieving a DTBT of 90min increased from 45% to 67% (P < 0.01). Lower mortality and major adverse cardiac event rates were observed with DTBT 90min (all P < 0.01). Multivariable analysis showed that a DTBT of 90min was associated with improved clinical outcomes at 12 months (odds ratio 0.48; 95% confidence interval 0.33-0.73, P < 0.01).ConclusionThere has been a decline in median DTBT in the Melbourne Interventional Group registry over 5 years. DTBT of 90min is associated with improved clinical outcomes at 12 months.

Background: Obesity is now the leading cause of premature death and illness in Australia. 2011 data estimate the prevalence of obesity (BMI >30 kg/m2) in Australian adults at 28.3% with a further 35% being overweight (BMI 25–29.9 kg/m2). A progressive rise in obesity prevalence has been observed over the last two decades. Methods: We prospectively collected data on 14,789 patients undergoing PCI at seven Australian public hospitals from 2005 to 2011. We measured the prevalence of obesity and examined temporal trends. Furthermore we assessed the impact of socioeconomic status using socioeconomic indexes for areas (SEIFAs) on obesity prevalence and compared cardiovascular risk factor prevalence in overweight, obese and normal weight groups. Results: The prevalence of obesity was 32.6% with a further 41.9% of patients being overweight. An increase in obesity prevalence was observed from 29.7% in 2005 to 33.5% in 2011 (p < 0.01). Obesity prevalence was higher in females and in younger patients with a progressive decline observed with increasing age (p < 0.01). No association between obesity and lower socioeconomic status was present (p = 0.15). The prevalence of diabetes, hypertension and dyslipidaemia increased with higher BMI. Conclusion: Obesity and overweight prevalence is very high in the Australian PCI population with levels exceeding that observed in the general population. Obesity prevalence is continuing to rise. However in contrast to the general population, we observed an inverse relationship between age and obesity prevalence and no association with socioeconomic status. A strong relationship exists between BMI level and prevalence of diabetes, hypertension and dyslipidaemia.

Aims: The aim of this study was to examine contemporary outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI). Methods: Analysis was made of the Melbourne Interventional Group registry which has collected consecutive patient PCI data (2005–2011). We assessed all-cause mortality and major adverse cardiovascular events (MACE) at 30 days and 12 months; specifically focusing on diabetic versus non-diabetic patients according to single (SVD) versus multi-vessel (MVD) disease. Results: The cohort included 17,545 PCI patients of which 4307 (24.5%) were diabetic. Of the diabetic group, 70.8% were male with a mean age of 64.6 ± 11.9 years, and 23.2% required insulin. Compared to non-diabetics, diabetics had higher all-cause mortality at 30 days (OR 1.62, 95% CI: 1.3–2.0, p < 0.001) and 12 months (OR 1.7, 95% CI: 1.5–2.0, p < 0.001). Diabetics also had higher MACE at 30 days (OR 1.4, 95% CI: 1.3–2.0, p < 0.001) and 12 months (OR 1.4, 95% CI: 1.3–1.6, p < 0.001). Diabetics with MVD undergoing PCI had worse outcomes than diabetics with SVD and non-diabetics. No difference in mortality was found between diabetics and non-diabetics with SVD undergoing PCI. Conclusion: Diabetic patients with coronary artery disease undergoing PCI are a high-risk cohort. Diabetic patients with MVD undergoing PCI have the highest mortality and need careful assessment prior to proceeding with PCI.