Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study
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...
| Main Authors: | , , , , , , , , |
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| Format: | Journal Article |
| Language: | English |
| Published: |
NATURE PUBLISHING GROUP
2019
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| Subjects: | |
| Online Access: | http://hdl.handle.net/20.500.11937/80065 |
| _version_ | 1848764153531990016 |
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| author | Foo, C.Y. Andrianopoulos, N. Brennan, Angela Ajani, A. Reid, Christopher Duffy, S.J. Clark, D.J. Reidpath, Daniel Chaiyakunapruk, N. |
| author_facet | Foo, C.Y. Andrianopoulos, N. Brennan, Angela Ajani, A. Reid, Christopher Duffy, S.J. Clark, D.J. Reidpath, Daniel Chaiyakunapruk, N. |
| author_sort | Foo, C.Y. |
| building | Curtin Institutional Repository |
| collection | Online Access |
| description | 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. |
| first_indexed | 2025-11-14T11:14:50Z |
| format | Journal Article |
| id | curtin-20.500.11937-80065 |
| institution | Curtin University Malaysia |
| institution_category | Local University |
| language | English |
| last_indexed | 2025-11-14T11:14:50Z |
| publishDate | 2019 |
| publisher | NATURE PUBLISHING GROUP |
| recordtype | eprints |
| repository_type | Digital Repository |
| spelling | curtin-20.500.11937-800652021-01-05T08:07:08Z Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study Foo, C.Y. Andrianopoulos, N. Brennan, Angela Ajani, A. Reid, Christopher Duffy, S.J. Clark, D.J. Reidpath, Daniel Chaiyakunapruk, N. Science & Technology Multidisciplinary Sciences Science & Technology - Other Topics PERCUTANEOUS CORONARY INTERVENTION INSTRUMENTAL VARIABLE METHODS MYOCARDIAL-INFARCTION PROPENSITY SCORE MORTALITY TIME RISK IMPACT CARE 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. 2019 Journal Article http://hdl.handle.net/20.500.11937/80065 10.1038/s41598-019-56353-7 English http://creativecommons.org/licenses/by/4.0/ NATURE PUBLISHING GROUP fulltext |
| spellingShingle | Science & Technology Multidisciplinary Sciences Science & Technology - Other Topics PERCUTANEOUS CORONARY INTERVENTION INSTRUMENTAL VARIABLE METHODS MYOCARDIAL-INFARCTION PROPENSITY SCORE MORTALITY TIME RISK IMPACT CARE Foo, C.Y. Andrianopoulos, N. Brennan, Angela Ajani, A. Reid, Christopher Duffy, S.J. Clark, D.J. Reidpath, Daniel Chaiyakunapruk, N. Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study |
| title | Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study |
| title_full | Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study |
| title_fullStr | Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study |
| title_full_unstemmed | Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study |
| title_short | Re-examining the effect of door-to-balloon delay on STEMI outcomes in the context of unmeasured confounders: a retrospective cohort study |
| title_sort | re-examining the effect of door-to-balloon delay on stemi outcomes in the context of unmeasured confounders: a retrospective cohort study |
| topic | Science & Technology Multidisciplinary Sciences Science & Technology - Other Topics PERCUTANEOUS CORONARY INTERVENTION INSTRUMENTAL VARIABLE METHODS MYOCARDIAL-INFARCTION PROPENSITY SCORE MORTALITY TIME RISK IMPACT CARE |
| url | http://hdl.handle.net/20.500.11937/80065 |