Relationship between treatment delay and final infarct size in STEMI patients treated with abciximab and primary PCI
Tim Tödt1, Eva Maret, Joakim Alfredsson
1Department of Medical and Health Sciences, Division of Cardiology, Linköping University, Linköping, Sweden. timtodt64@gmail.com
Insights
For ST-Elevation Myocardial Infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI), healthcare delay time showed a weak correlation with final infarct size. Other factors, such as artery status and location, were more influential than time to treatment alone.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Conflicting results exist regarding the impact of treatment delay on myocardial infarct size.
- ST-Elevation Myocardial Infarction (STEMI) is a critical condition requiring timely intervention.
- Primary percutaneous coronary intervention (PCI) is a standard treatment for STEMI.
Purpose of the Study:
- To investigate the relationship between time from First Medical Contact (FMC) to an open infarct-related artery (IRA) and final myocardial scar size in STEMI patients treated with primary PCI.
- To identify factors independently associated with infarct size in this patient population.
Main Methods:
- A cohort of 89 STEMI patients treated with primary PCI were studied.
- Contrast-enhanced magnetic resonance imaging (ceMRI) was used to assess infarct size 4-8 weeks post-infarction.
- Spearman correlation and multiple linear regression analyses were employed to evaluate the association between delay times and infarct size, controlling for covariates.
Main Results:
- A weak correlation (r = 0.27, p = 0.01) was found between the time from FMC to a patent IRA and infarct size.
- In multiple regression, Left Anterior Descending (LAD) artery involvement, smoking, and an initially occluded vessel correlated with infarct size.
- Healthcare delay time (FMC to PCI) was not an independent predictor of infarct size.
Conclusions:
- In STEMI patients undergoing primary PCI, healthcare delay time has a weak correlation with infarct size.
- Factors such as anterior infarction, pre-PCI artery patency, and reperfusion injury may significantly influence infarct size.
- Time-to-treatment alone may be less critical than other clinical and anatomical factors in determining final myocardial damage.
Background:
Studies on the impact of time to treatment on myocardial infarct size have yielded conflicting results. In this study of ST-Elevation Myocardial Infarction (STEMI) treated with primary percutaneous coronary intervention (PCI), we set out to investigate the relationship between the time from First Medical Contact (FMC) to the demonstration of an open infarct related artery (IRA) and final scar size.Between February 2006 and September 2007, 89 STEMI patients treated with primary PCI were studied with contrast enhanced magnetic resonance imaging (ceMRI) 4 to 8 weeks after the infarction. Spearman correlation was computed for health care delay time (defined as time from FMC to PCI) and myocardial injury. Multiple linear regression was used to determine covariates independently associated with infarct size.
Results:
An occluded artery (Thrombolysis In Myocardial Infarction, TIMI flow 0-1 at initial angiogram) was seen in 56 patients (63%). The median FMC-to-patent artery was 89 minutes. There was a weak correlation between time from FMC-to-patent IRA and infarct size, r = 0.27, p = 0.01. In multiple regression analyses, LAD as the IRA, smoking and an occluded vessel at the first angiogram, but not delay time, correlated with infarct size.
Conclusions:
In patients with STEMI treated with primary PCI we found a weak correlation between health care delay time and infarct size. Other factors like anterior infarction, a patent artery pre-PCI and effects of reperfusion injury may have had greater influence on infarct size than time-to-treatment per se.
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