Symptom-to-door time in ST segment elevation myocardial infarction: overemphasized or overlooked? Results from the
Jonathan Afilalo1, Nicolo Piazza, Sonia Tremblay
1Sir Mortimer B Davis Jewish General Hospital, Montreal, Quebec.
Insights
For ST-elevation myocardial infarction (STEMI) patients, longer symptom-to-door times significantly reduce left ventricular ejection fraction (LVEF). Educating high-risk individuals on heart attack symptoms is crucial for improving outcomes.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Ischemic time is a critical determinant of infarct size in ST-elevation myocardial infarction (STEMI).
- While door-to-reperfusion therapy is emphasized, symptom-to-door time is often overlooked.
- Reducing delays in STEMI treatment is vital for preserving cardiac function.
Purpose of the Study:
- To investigate the correlation between symptom-to-door time and left ventricular ejection fraction (LVEF) in STEMI patients.
- To identify factors influencing post-infarction cardiac function.
Main Methods:
- A cohort study (AMI-McGill) involving consecutive STEMI patients from three university hospitals.
- Multivariate linear regression analysis was used to correlate symptom-to-door time with postinfarction LVEF.
- Adjustments were made for reperfusion method, prior myocardial infarction, and TIMI risk score components.
Main Results:
- 188 STEMI patients (mean age 66) were analyzed.
- Median symptom-to-door time was 120 minutes; median door-to-reperfusion time was 93 minutes.
- Symptom-to-door time (beta: -0.66, P=0.01), Killip class II-IV (beta: -6.43, P=0.02), and anterior infarction territory (beta: -5.86, P=0.02) were independently correlated with lower LVEF.
Conclusions:
- Symptom-to-door time is negatively correlated with postinfarction LVEF in STEMI patients.
- Strategies to shorten patient delay are essential for improving cardiac outcomes.
- Patient education on recognizing STEMI symptoms should be prioritized.
Background:
Ischemic time is a major determinant of infarct size in ST segment elevation myocardial infarction (STEMI). Emphasis is placed on reducing the door-to-reperfusion therapy time component, whereas the symptom-to-door time is often overlooked.
Objectives:
To correlate the symptom-to-door time with left ventricular ejection fraction (LVEF) in patients with STEMI.
Methods:
Acute Myocardial Infarction (AMI)-McGill was a cohort study of consecutive patients with STEMI who presented to three adult university hospitals. Multivariate linear regression was performed to correlate the symptom-to-door time with postinfarction LVEF adjusted for reperfusion method, prior myocardial infarction and components of the Thrombolysis In Myocardial Infarction (TIMI) risk score.
Results:
There were 188 patients, with a mean age of 66 years. On arrival to hospital, 23% of patients were in Killip class II to IV and 87% received reperfusion therapy (20% fibrinolytic therapy and 67% primary percutaneous coronary intervention). The median symptom-to-door time was 120 min (first quartile: 60 min, third quartile: 290 min) and the median door-to-reperfusion therapy time was 93 min (first quartile: 54 min, third quartile: 155 min). Three variables were independently correlated with LVEF in the study's regression model: symptom-to-door time (beta: -0.66, 95% CI -1.18 to -0.14; P=0.01), Killip class II to IV on arrival (beta: -6.43, 95% CI -11.87 to -0.99; P=0.02) and anterior territory of the infarction (beta: -5.86, 95% CI -10.55 to -1.18; P=0.02).
Conclusions:
Symptom-to-door time was negatively correlated with postinfarction LVEF in patients with STEMI. Strategies to shorten this delay, such as educating high-risk patients about the symptoms of AMI, should be considered.
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