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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Relation of lowering door-to-balloon time and mortality in ST segment elevation myocardial infarction patients
David Zahler1, Keren Lee-Rozenfeld2, Dor Ravid2
1Division of Cardiovascular Diseases and Internal Medicine, Department of Cardiology, Tel-Aviv Sourasky Medical Center affiliated to the Sackler Faculty of Medicine, Tel-Aviv University, 6 Weizmann Street, Tel-Aviv, Israel. David.zahler@gmail.com.
Insights
Reducing door-to-balloon time (DBT) to under 60 minutes for ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI) significantly lowers 1-year mortality. This further reduction beyond 90 minutes offers improved patient outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Current guidelines recommend a door-to-balloon time (DBT) of ≤90 minutes for ST-segment elevation myocardial infarction (STEMI) patients receiving primary percutaneous coronary intervention (PCI).
- The impact of further reducing DBT intervals below the 90-minute threshold on patient outcomes remains an area of investigation.
Purpose of the Study:
- To evaluate the effect of a DBT <60 minutes compared to a DBT of 60-90 minutes on short- and long-term outcomes in STEMI patients undergoing primary PCI.
- To determine if a shorter DBT is independently associated with improved mortality rates.
Main Methods:
- Retrospective analysis of 889 STEMI patients who underwent successful primary PCI with a DBT ≤90 minutes.
- Patients were stratified into two groups: DBT <60 minutes and DBT 60-90 minutes.
- Assessment of in-hospital complications, 30-day, and 1-year mortality.
Main Results:
- Patients with DBT <60 minutes (n=608) had better post-procedural left ventricular ejection fraction and lower 30-day mortality (3% vs. 6%, p=0.03).
- One-year mortality was significantly lower in the DBT <60 minutes group (4.6% vs. 9.6%, p=0.004).
- A DBT <60 minutes was associated with a 51% risk reduction in 1-year mortality (OR 0.49, 95% CI 0.25-0.93, p=0.03).
Conclusions:
- A DBT <60 minutes is independently associated with improved 1-year mortality in STEMI patients undergoing primary PCI within 90 minutes.
- Further reduction of DBT below 60 minutes may offer significant survival benefits for STEMI patients.
Background:
Current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommend a door-to-balloon time (DBT) of ≤ 90 min for patients undergoing primary percutaneous coronary intervention (PCI). We aimed to investigate the possible impact of further reduction in DBT intervals beyond the 90 min cutoff on short and long-term outcomes among STEMI patients undergoing primary PCI.
Methods:
We retrospectively studied 889 STEMI patients (median age 61 years, 83% men) who underwent successful primary PCI and had a DBT of ≤ 90 min. Patients were stratified according to DBT into 2 groups: < 60 min and 60-90 min. Patients records were assessed for the occurrence of in-hospital complications, 30-day and 1-year mortality.
Results:
Patients having DBT < 60 min (n = 608, 68%) were more likely to present earlier, in daytime and weekdays, and had better post-procedural left ventricular ejection fraction and lower 30-day mortality (3% vs. 6%, p = 0.03). Mortality over 1-year was significantly lower among patients having DBT < 60 compared to DBT of 60-90 min (4.6% vs. 9.6%, p = 0.004). In a binary logistic regression model DBT < 60 min was associated with 51% risk reduction for 1-year mortality (OR 0.49, 95% CI 0.25-0.93, p = 0.03).
Conclusions:
Among STEMI patients undergoing primary PCI within 90 min of admission DBT < 60 min was independently associated with better 1-year mortality.
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