Influence of Total Ischemic Time on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction

Abstract

Aim To evaluate the effect of the total time of myocardial ischemia on results of the treatment of patients with ST segment elevation acute myocardial infarction (STEMI) who underwent percutaneous coronary interventions (PCI).Material and methods This study used data from a hospital register for PCI in STEMI from 2006 through 2017. 1649 patients were included. Group 1 consisted of 604 (36.6 %) patients with a total time of myocardial ischemia not exceeding 1880 min; group 2 included 531 (32.2 %) patients with a duration of myocardial ischemia from 180 to 360 min; and group 3 included 514 (31.2 %) patients with a duration of myocardial ischemia longer than 360 min.Results Mortality was lower in group 1 (2.3 %) than in groups 2 and 3 (6.2 and 7.2 %, respectively; p1–2=0.001; p1–3<0.001; p2–3=0.520). The incidence of major cardiac complications (“adverse cardiac events”, MACE) was lower in group 1 (4.1 %) than in groups 2 and 3 (7.3 and 9.5 %, respectively, p1–2=0.020; p1–3<0.001; p2–3=0.200). The incidence of no-reflow phenomenon was higher in group 3 (9.7 %) than in groups 2 and 3 (4.5 and 5.3 %, respectively (p1–2=0.539; p1–3=0.001; p2–3=0.005). The major factors associated with the increased total time of myocardial ischemia >180 min were age (odd ratio, OR, 1.01 at 95 % confidence interval, CI, 1.0 to 1.02; р=0.044), female gender (OR, 1.64 at 95 % CI 1.26 to 2.13; р<0.001), chronic kidney disease (OR 1.82 at 95 % CI 1.21 to 2.74; р=0.004). Performing prehospital thrombolysis was associated with a decrease in the total time of myocardial ischemia (OR 0.4 at 95 % CI 0.31 to 0.51; р<0.001). A strong direct correlation was observed between the total time of myocardial ischemia and the time from the onset of pain syndrome to hospitalization (r=0.759; р<0.001).Conclusion The total time of myocardial ischemia >180 min was associated with increased mortality and development of MACE. The total time of myocardial ischemia > 360 min was associated with increased incidence of the no-reflow phenomenon. The major predictors for the time of myocardial ischemia >180 min included age, female gender, and chronic kidney disease. The use of pharmacoinvasive strategy was associated with an increased number of patients with a total duration of myocardial ischemia <180 min. The contribution of the time of prehospital delay to the total time of myocardial ischemia was greater than the contribution of the “door-to-balloon” time. The time of prehospital delay showed a strong direct correlation with the total time of myocardial ischemia.

Effects of ferroptosis in myocardial ischemia/reperfusion model of rat and its association with Sestrin 1

“…The total time of myocardial ischemia was frequently reported to be associated with an increased incidence of the no-reflow phenomenon. 30,31 Research revealed that prolonged total ischemic time was an independent predictor of the no-reflow phenomenon. 32 The present study depicted that no matter how long the time of myocardial ischemia (2-6 h), ferroptosis only occurred during the reperfusion phase, and the myocardial injury was alleviated after the administration of a ferroptosis inhibitor -Fer-1.…”

Clinical factors associated with the no/slow-reflow phenomenon in patients with acute coronary syndrome

“…Так в исследовании И. С. Бессонова и соавт. было показано, что увеличение времени до реваскуляризации >360 мин коррелирует с большей частотой возникновения феномена невосстановленного кровотока [26]. Чем дольше продолжается ишемия миокарда, тем больше повреждается клеток и тканей, происходит эскалация таких процессов, как набухание эндотелиоцитов, адгезия лейкоцитов к внутренней оболочке артерий, обтурация лейкоцитами и тромбоцитами капилляров, повышение сосудис той проницаемости и межклеточный отек, диапедез эритроцитов и нейтрофилов.…”

Chinese Expert Consensus on Microvascular Protection Strategy During Emergency Percutaneous Coronary Intervention Therapy in Patients With ST-elevation Myocardial Infarction

“…The longer the ischemia time in STEMI patients, the higher the incidence of no-reflow. [10] A STEMI registry study demonstrated that the 6-month mortality of patients undergoing primary PCI (PPCI) increased by 0.18% for each 10 min delay in door-balloon time. [11] In addition to optimizing the reception process of patients with STEMI, it is vital to strengthen public health education, popularize medical knowledge, and shorten patients visiting time.…”