Total ischaemic time and 9-year outcomes in STEMI patients treated with pPCI
M Polańska-Skrzypczyk1, M Karcz1, P Bekta1
1Institute of Cardiology, Department of Interventional Cardiology and Angiology, Warsaw, Poland.
Insights
Prolonged total ischaemic time (TIT) in ST-elevation myocardial infarction (STEMI) patients significantly increases long-term mortality risk. Reducing TIT is crucial for improving survival outcomes in STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- Prolonged total ischaemic time (TIT) is linked to poor myocardial perfusion and in-hospital mortality in STEMI patients.
- The impact of TIT on long-term outcomes and associated factors in STEMI patients undergoing primary percutaneous coronary intervention (pPCI) requires further investigation.
Purpose of the Study:
- To evaluate the influence of TIT on long-term follow-up (F/U) mortality in STEMI patients treated with pPCI.
- To identify clinical and procedural factors associated with prolonged TIT in this patient cohort.
Main Methods:
- Prospective registry of consecutive STEMI patients treated with pPCI.
- Patients categorized into three groups based on TIT: <3 hours, 3-6 hours, and >6 hours.
- Analysis of clinical, angiographic, procedural characteristics, and 9-year mortality.
Main Results:
- Longer TIT was significantly associated with increased 9-year mortality (21% for <3h, 28% for 3-6h, 37% for >6h; p<0.0005).
- TIT >6 hours was independently linked to advanced age, diabetes, history of coronary artery disease (CAD), and higher initial TIMI flow grade 3.
- Patients with shorter TIT had better final TIMI 3 flow rates.
Conclusions:
- Total ischaemic time is a strong predictor of long-term mortality in STEMI patients, persisting up to nine years post-treatment.
- Emphasizes the critical importance of minimizing TIT in all STEMI patients to improve survival.
Background:
Prolonged total ischaemic time (TIT) has been shown to independently predict poor myocardial perfusion in STEMI patients and affect in-hospital mortality. We aim to evaluate the influence of TIT on long-term follow-up (F/U) and identify the factors associated with TIT in patients with STEMI treated with pPCI at a high volume centre.
Methods:
In a prospective "all-comer" registry, clinical, angiographic and procedural characteristics, TIT and 9-year mortality were determined in consecutive STEMI patients treated with pPCI. Patients were divided according to TIT into three groups: A) <3, B) 3-6 and C) >6h.
Results:
Among 1064 patients, TIT was known in 1002 patients, 5 patients were lost to F/U. For censored observations F/U was 7.2-8.8 years. There were 350, 461, and 186 patients in groups A, B, and C, respectively. Patients in group A compared to B and C were younger, more often males and smokers, less frequently had history of CAD, and more frequently had occluded infarct related artery. However, final TIMI3 was obtained more frequently. Overall 30-day mortality was 4%, one-year mortality 7% and nine-year mortality 27%. Multivariable logistic regression models indicated that longer TIT was associated with a higher risk of 9-year mortality (A-21%, B-28%, C-37%, p<0.0005). TIT>6h was independently associated with advanced age, diabetes mellitus, history of CAD and higher rate of initial TIMI grade flow 3.
Conclusions:
TIT is strongly related with mortality in STEMI patients even after nine years of F/U. This finding reinforces the necessity of shortening the TIT in all STEMI patients.
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:28Acute Coronary Syndrome IV: Interprofessional Care