Mortality in patients with TIMI 3 flow after PCI in relation to time delay to reperfusion
Insights
Delayed reperfusion after percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) with bundle branch block (BBB) increases 1-year mortality. Even with restored blood flow, longer time to treatment significantly impacts patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Percutaneous coronary intervention (PCI) aims for rapid restoration of blood flow in ST-elevation myocardial infarction (STEMI).
- Despite achieving TIMI 3 flow, myocardial perfusion may remain suboptimal, impacting patient prognosis.
- The relationship between reperfusion time and outcomes in STEMI with bundle branch block (BBB) requires further investigation.
Purpose of the Study:
- To investigate the association between time to reperfusion and 1-year mortality in STEMI/BBB patients with successful PCI (TIMI 3 flow).
Main Methods:
- Retrospective analysis of 635 STEMI/BBB patients undergoing PCI with postprocedural TIMI 3 flow.
- Evaluation of 1-year mortality in relation to time from symptom onset to reperfusion.
- Multivariate logistic regression to identify predictors of mortality.
Main Results:
- 1-year mortality was 13.07% (83 patients).
- Median time to reperfusion was significantly longer in non-survivors (6.0h vs. 3.92h).
- Time delay ≥ 9 hours (OR 1.958), LVEF < 30%, age > 65, Killip class >2, female gender, and creatinine clearance < 30 mL/min were associated with increased mortality.
Conclusions:
- Time to reperfusion is a significant predictor of 1-year mortality in STEMI/BBB patients with TIMI 3 flow after PCI.
- Early reperfusion is crucial for improving outcomes even when epicardial blood flow is restored.
Background:
Percutaneous coronary intervention (PCI) performed within 12 h from symptom onset enables complete blood flow restoration in infarct-related artery in 90% of patients. Nevertheless, even with complete restoration of epicardial blood flow in culprit vessel (postprocedural Thrombolysis in Myocardial Infarction (TIMI) flow grade 3), myocardial perfusion at tissue level may be insufficient. We hypothesized that the outcome of patients with STEMI/bundle branch block (BBB)-myocardial infarction and post-PCI TIMI 3 flow is related to the time to reperfusion.
Methods:
Observational study based on a retrospective analysis of population of 635 consecutive patients with STEMI/BBB-MI and post-PCI TIMI 3 flow from January 2009 to December 2011 (mean age 63 years, 69.6% males). Mortality of patients was evaluated in relation to the time from symptom onset to reperfusion.
Results:
A total of 83 patients (13.07%) with postprocedural TIMI 3 flow after PCI had died at 1-year follow-up. Median TD in patients who survived was 3.92 h (iqr 5.43), in patients who died 6.0 h (iqr 11.42), P = 0.004. Multiple logistic regression analysis identified time delay ≥ 9 h as significantly related to 1-year mortality of patients with STEMI/BBB-MI and post-PCI TIMI 3 flow (OR 1.958, P = 0.026). Other significant variables associated with mortality in multivariate regression analysis were: left ventricle ejection fraction < 30% (P = 0.006), age > 65 years (P < 0.001), Killip class >2 (P <0.001), female gender (P = 0.019), and creatinine clearance < 30 mL/min (P < 0.001).
Conclusion:
Time delay to reperfusion is significantly related to 1-year mortality of patients with STEMI/BBB-MI and complete restoration of epicardial blood flow in culprit vessel after PCI.
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