Guideline‐Recommended Time Less Than 90 Minutes From ECG to Primary Percutaneous Coronary Intervention for ST‐Segment–Elevation Myocardial Infarction Is Associated with Major Survival Benefits, Especially in Octogenarians: A Contemporary Report in 11 226 Patients from NORIC

Abstract

Background Using contemporary data from NORIC (Norwegian Registry of Invasive Cardiology) we investigated the predictive value of patient age and time from ECG diagnosis to sheath insertion (ECG‐2‐sheath) in primary percutaneous coronary intervention for ST‐segment–elevation myocardial infarction (STEMI). Methods and Results Data from 11 226 patients collected from all centers offering 24/7/365 primary percutaneous coronary intervention service were explored. For patients aged <80 years the mortality rates were 5.6% and 7.6% at 30 days and 1 year, respectively. For octogenarians the corresponding rates were 15.0% and 24.2%. The Cox hazard ratio was 2.02 (1.93–2.11, P value <0.0001) per 10 years of patient age. Time from ECG‐2‐sheath was significantly associated with mortality with a 3.6% increase per 30 minutes of time. Using achievement of time goal <90 minutes in patients aged >80 years and mortality at 30 days, mortality was 10.5% and 17.7% for <90 or ≥90 minutes, respectively. The number needed to prevent 1 death was 39 in the whole population and 14 in the elderly. Restricted mean survival gains during median 938 days of follow‐up in patients with ECG‐2‐sheath time <90 minutes were 24 and 76 days for patients aged <80 and ≥80 years, respectively. Conclusions Time from ECG‐diagnosis to sheath insertion is strongly correlated with mortality. This applies especially to octogenarians who derive the most in terms of absolute mortality reduction. Registration URL: https://helsedata.no/en/forvaltere/norwegian‐institute‐of‐public‐health/norwegian‐registry‐of‐invasive‐cardiology/ .

Prediction models for major adverse cardiovascular events following ST-segment elevation myocardial infarction and subgroup-specific performance

“…Of note, ST-segment deviations are essential in standardized guidelines for the diagnosis of myocardial ischemia, the assessment of ischemia severity, and the prognosis evaluation ( 19 ). Consistent with a previous report ( 20 ), we demonstrated that age is a risk factor for MACEs prediction in patients with STEMI. Previous studies have demonstrated that renal dysfunction is an important risk factor after acute MI ( 21 ).…”

“…ST-segment deviations caused by loss of the cell membrane in the injured myocardium (18) had the greatest contribution in our model. Of note, ST-segment deviations are essential in standardized guidelines for the diagnosis of myocardial ischemia, the assessment of ischemia severity, and the prognosis evaluation (19). Consistent with a previous report (20), we demonstrated that age is a risk factor for MACEs prediction in patients with STEMI.…”

Which treatment strategy is preferred in the octogenarians with acute coronary syndrome?

“…This confirmed that meeting time targets of <90 minutes recommended in the guidelines was associated with a large survival benefit, especially among the octogenarians. 18 The current findings as well as those reported in literature 10,18 indicated better survival through invasive strategy even in older patients. 5 The current study has limitations as it was a single-centre, observational, retrospective study, and STEMI and NSTEMI patients were not separately compared because of the small sample size.…”

“…Larsen et al 18 recently conducted a study comprising 11,226 patients who underwent primary PCI for STEMI. Of them, 1,400 patients were over 80 years old.…”

Delay in Door-to-door-to-balloon time for Primary PCI is rarely Related to Cardiologists Late Arrival

“…While organizational measures can enhance the system delay, patient delay is influenced by multiple factors. System delay serves as a prognostic indicator for mortality in STEMI patients undergoing primary PCI (1)(2)(3). So, one of the key factors in effectively managing patients with STEMI is minimizing the time from hospital arrival to balloon inflation, commonly referred to as door-to-balloon time (DBT).…”