Survivorship With Incrementally Faster Times to Primary Percutaneous Coronary Intervention (SWIFT-PPCI): A Systematic Review and Meta-Analysis

• Published in: The American journal of cardiology 2023-11, Vol.207, p.356-362
• Main Authors: Price, James, Rudman, Jordan, Schoenfeld, David, Thomas, Sarah Alice, Rees, Paul, Bloom, Ben, McCartin, Michael, Blumen, Ira, Thomas, Stephen H.
• Format: Article
• Language: English
• Subjects: Angioplasty; Emergency medical care; Emergency medical services; Health services; Heterogeneity; Mathematical analysis; Meta-analysis; Mortality; Mortality risk; Myocardial infarction; Patients; primary percutaneous coronary intervention; Risk management; Risk reduction; ST-elevation myocardial infarction; Survival; Systematic review; Time measurement
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2023.08.178

In the United States, there are approximately 750,000 ST-elevation myocardial infarction cases each year. Streamlined care and rapid delivery for primary percutaneous coronary intervention (PPCI) is associated with improved survival. This systematic review and meta-analysis aimed to generate a practical estimate of mortality savings for every notional 30-minute decrease in the time to achieving PPCI. Included studies were those that provided a specific absolute risk reduction for a specific reduction in pre-PPCI time. The eligible studies evaluated the survival benefit from pre-PPCI time savings measured in any interval ending with PPCI and commencing with objectively recorded timing, such as initial emergency call, first medical contact, or hospital arrival. Study planning called for the reporting of data as individual study results, with a pooled effect estimate of relative risk calculated with random-effects meta-analysis. A total of 1,088 records were eligible for review; 52 were reviewed in full text, with 4 studies (total patient n = 235,814, overall mortality 4.7% to 7.8%) included in the final analysis. All 4 studies reported significant time-related survival benefit over the study focus window of 60 to 180 minutes pre-PPCI. The number of lives saved per 100 cases for each 30-minute pre-PPCI time savings ranged from 0.8 to 1.9. The overall effect estimate generated was 0.753 (95% confidence interval 0.712 to 0.796), with acceptable heterogeneity (I2 = 36%). In conclusion, a pooled effect calculation estimated a 24.7% relative risk reduction for each 30 minutes of time savings. For cases that underwent PPCI within 60 to 180 minutes of initial presentation with known baseline mortality risk, the time savings in 30-minute epochs can be leveraged to estimate a specific number of lives saved; this may be useful for those involved in the organization of medical care who make systemwide plans and individual patient triage decisions.