Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction

Abstract

BackgroundIn patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion.AimsTo assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times.MethodsA total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included.ResultsThere were 1554 deaths (7.8%) with a J-shaped relationship between mortality and S2C time. Mortality was 10.0% in patients presenting within 1 hour, and 4.9%, 6.0% and 7.3% in patient groups with longer S2C intervals of 1–2 hours, 2–6 hours and 6–24 hours, respectively. Patients with a short S2C interval of less than 1 hour (S2C<60 min) had the highest survival benefit from timely reperfusion with PCI within 90 min (OR 0.27, 95% CI 0.23 to 0.31, p<0.0001) as compared with the three groups with longer S2C intervals of 1 hour<S2C≤2 hours (OR 0.44, 95% CI 0.33 to 0.59, p<0.0001), 2 hours<S2C≤6 hours (OR 0.49, 95% CI 0.38 to 0.64, p<0.0001) and 6 hours<S2C≤24 hours (OR 0.42, 95% CI 0.30 to 0.58, p<0.0001).ConclusionsTimely reperfusion with a contact-to-balloon time of less than 90 min is most effective in patients presenting with short S2C intervals of less than 1 hour, but has also beneficial effects in patients with S2C intervals of up to 24 hours.Trial registration numberNCT00794001.

Comparing Door-To-Balloon Time between ST-Elevation Myocardial Infarction Electrocardiogram and Its Equivalents

“…Multivariable logistic regression analysis also showed that STEMI-equivalent ECG was an independent factor of DTB time delayed for more than 90 min, which is known to be associated with an unfavorable outcome in the study population. Our study also corroborated with previous studies in that delayed DTB time was an independent predictor of in-hospital MACE [ 7 , 8 , 10 , 11 , 13 ], indicating that the principle of valuing every minute for AMI patients might also be applied to patients with STEMI-equivalent ECGs, and timely reperfusion would be beneficial for this study population.…”

“…Reducing the ischemic time from symptom onset to coronary reperfusion is crucial, and door-to-balloon (DTB) time, defined as the time duration from patient arrival at the emergency department (ED) to device placement on an infarct coronary artery, is frequently used as an indicator of adequate pPCI performance [ 6 ]. Previous studies have shown that delayed DTB time is associated with an unfavorable outcome in patients with STEMI [ 7 , 8 , 9 , 10 , 11 , 12 , 13 ]. Therefore, clinical guidelines recommend maintaining shorter ischemic time for these patients [ 2 , 3 ].…”

Delays in first medical contact to primary interventional therapy and left ventricular remodelling in ST-segment elevation myocardial infarction

“…However, D2B time only focuses on the final component of the regional systems of care, and more recently, FMC2B time has been considered a more relevant indicator because it includes all factors involved in the healthcare chain for STEMI patients [ 6 ]. Scholz et al [ 7 ] demonstrated that timely revascularisation with an FMC2B time of < 90 min was a crucial component of improving the in-hospital mortality of STEMI patients, but there was no observation of what happened to the patients after they were discharged from the hospital.…”

Metallothionein-2A protect Cardiomyocytes from Ischemia/Reperfusion through inhibiting p38

“…Ischemic heart disease is one of the leading causes of death in human and timely reperfusion is the most effective method for the treatment of acute myocardial infarction [1]. However, studies have found that reperfusion may cause cardiomyocyte injury and this process is often called myocardial ischemia/reperfusion (I/R) injury [2].…”