Time-to-treatment and infarct size in STEMI patients undergoing primary angioplasty
Giuseppe De Luca1, Guido Parodi, Roberto Sciagrà
1Division of Cardiology, Maggiore della Carità Hospital, Eastern Piedmont University, Novara, Italy. g.deluca@diagram-zwolle.nl
Insights
For ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI), longer time to treatment directly correlates with increased infarct size. This finding emphasizes the critical importance of timely intervention to minimize heart muscle damage.
Area of Science:
- Cardiology
- Interventional Cardiology
- Nuclear Cardiology
Background:
- Longer ischemia time in ST-segment elevation acute myocardial infarction (STEMI) is linked to worse outcomes.
- The role of reperfusion time in primary percutaneous coronary intervention (PCI) for STEMI requires further clarification.
Purpose of the Study:
- To investigate the association between time-to-treatment and infarct size in STEMI patients undergoing primary PCI.
- To quantify the impact of treatment delay on myocardial damage using scintigraphy.
Main Methods:
- A cohort of 830 STEMI patients treated with primary PCI was analyzed.
- Infarct size was assessed at 30 days using technetium-99m-sestamibi myocardial scintigraphy.
Main Results:
- Time-to-treatment showed a linear association with both postprocedural TIMI 3 flow and scintigraphic infarct size (p<0.001).
- This association remained significant even after adjusting for confounding factors like age and dyslipidemia (OR [95% CI]=1.26 [1.14-1.39], p<0.001).
Conclusions:
- In STEMI patients undergoing primary PCI, treatment delay is linearly associated with larger infarct size.
- Timely reperfusion is crucial for limiting myocardial damage in STEMI.
Background:
Several reports have shown that in patient with ST-segment elevation acute myocardial infarction (STEMI) longer ischemia time is associated with impaired reperfusion and higher mortality. However, there is still some doubts with regards time to reperfusion role in patients treated with primary percutaneous coronary intervention (PCI). Therefore, the aim of the current study was to evaluate the impact of time-to-treatment on infarct size as evaluated by myocardial scintigraphy in a large cohort of STEMI patients undergoing primary PCI.
Methods:
Our population is represented by 830 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi.
Results:
Time-to-treatment was significantly associated with age and dyslipidemia. Time-to-treatment linearly affected the rate of postprocedural TIMI 3 flow (p<0.0001) and scintigraphic infarct size (p<0.001). The impact of time-to-treatment on infarct size persisted in the analysis restricted to patients with postpocedural TIMI 3 flow, and after correction for confounding factors such as age, dyslipidemia, postprocedural TIMI 3 flow (OR [95% CI]=1.26 [1.14-1.39], p<0.001).
Conclusions:
This study shows in a large population of STEMI patients undergoing primary PCI that time-to-treatment is linearly associated with infarct size.
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