{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:10:21Z","timestamp":1792098621114,"version":"4.4.0"},"reference-count":25,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Quality and Outcomes"],"published-print":{"date-parts":[[2018,8]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Expediting reperfusion during primary percutaneous coronary intervention is aimed at salvaging myocardium in ST-segment\u2013elevation myocardial infarction. Few studies have examined the relation between reperfusion time and heart failure (HF) events.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and Results:<\/jats:title><jats:p>We studied 7597 patients undergoing primary percutaneous coronary intervention from 2007 to 2013 in the Singapore Myocardial Infarct Registry, which captures HF at admission, postadmission in-hospital HF, and HF rehospitalization. We studied the relation of first medical contact to deployment of first device to achieve reperfusion (FTD) time with in-hospital HF events and HF rehospitalization, with mortality modeled as a competing risk. At the population level, median FTD time decreased from 91 minutes (interquartile range, 69\u2013114) in 2007 to 58 minutes (45\u201375) in 2013 (<jats:italic>P<\/jats:italic>=0.001), whereas mortality remained unchanged (in-hospital: range 5.3%\u20137.3%;<jats:italic>P<\/jats:italic>=0.190 and 1-year: range 7.8%\u201310.9%;<jats:italic>P<\/jats:italic>=0.505). HF at admission increased from 12.2% in 2007 to 18.4% in 2013,<jats:italic>P<\/jats:italic>=0.020, whereas postadmission in-hospital HF decreased from 12.8% in 2007 to 7.1% in 2013,<jats:italic>P<\/jats:italic>=0.030. HF rehospitalization increased from 1.2% in 2007 to 2.6% in 2013 (<jats:italic>P<\/jats:italic>=0.003), for 30-day HF rehospitalization, and 3.8% in 2007 to 5.6% in 2013 (<jats:italic>P<\/jats:italic>=0.037), for 1-year HF rehospitalization. At the individual level, among patients with HF at admission (N=1191), longer FTD time was associated with more 30-day HF rehospitalization (compared with \u226460 minutes, adjusted hazard ratio, 1.68 [0.73\u20133.86] for 60\u201390 minutes, 2.88 [1.19\u20136.92], for 90\u2013120 minutes, and 2.84 [1.08\u20137.44] for &gt;120 minutes). Longer FTD time was associated with a greater risk of postadmission in-hospital HF (compared with \u226460 minutes, adjusted hazard ratio, 1.18 [0.96\u20131.44] for 60\u201390 minutes, 1.59 [1.25\u20132.03] for 90\u2013120 minutes, and 1.67 [1.26\u20132.21] for &gt;120 minutes).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions:<\/jats:title><jats:p>Temporal reductions in FTD time were associated with decrease in postadmission in-hospital HF. Among patients presenting with HF at admission, delays in FTD beyond 90 minutes were associated with more 30-day HF rehospitalization.<\/jats:p><\/jats:sec>","DOI":"10.1161\/circoutcomes.118.004699","type":"journal-article","created":{"date-parts":[[2018,9,16]],"date-time":"2018-09-16T10:17:06Z","timestamp":1537093026000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":15,"title":["First Medical Contact-to-Device Time and Heart Failure Outcomes Among Patients Undergoing Primary Percutaneous Coronary Intervention"],"prefix":"10.1161","volume":"11","author":[{"given":"Joshua P.","family":"Loh","sequence":"first","affiliation":[{"name":"National University Heart Centre Singapore (J.P.L., L.-L.T., H-C.T., A.M.R., M.Y.C.)."},{"name":"Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Li-Ling","family":"Tan","sequence":"additional","affiliation":[{"name":"National University Heart Centre Singapore (J.P.L., L.-L.T., H-C.T., A.M.R., M.Y.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huili","family":"Zheng","sequence":"additional","affiliation":[{"name":"National Registry of Disease Office, Singapore (H.Z., L.-L.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yee-How","family":"Lau","sequence":"additional","affiliation":[{"name":"Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siew-Pang","family":"Chan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kelvin-Bryan","family":"Tan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terrance","family":"Chua","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huay-Cheem","family":"Tan","sequence":"additional","affiliation":[{"name":"National University Heart Centre Singapore (J.P.L., L.-L.T., H-C.T., A.M.R., M.Y.C.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Foo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chee-Wan","family":"Lee","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khim-Leng","family":"Tong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ling-Li","family":"Foo","sequence":"additional","affiliation":[{"name":"National Registry of Disease Office, Singapore (H.Z., L.-L.F.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Derek","family":"Hausenloy","sequence":"additional","affiliation":[{"name":"Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anders","family":"Sahlen","sequence":"additional","affiliation":[{"name":"Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khung-Keong","family":"Yeo","sequence":"additional","affiliation":[{"name":"Singapore Cardiac Databank, National Heart Centre (Y.-H.L., D.H., A.S., K.-K.Y., J.P.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith A.A.","family":"Fox","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tracy Y.","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. 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