Influence of Total Ischemic Time on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction
I S Bessonov1, V A Kuznetsov1, E A Gorbatenko1
1Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk.
Insights
Prolonged myocardial ischemia time exceeding 180 minutes in ST-elevation myocardial infarction (STEMI) patients undergoing percutaneous coronary intervention (PCI) is linked to higher mortality and major adverse cardiac events (MACE). Shorter ischemia times improve treatment outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Research
Background:
- ST-elevation acute myocardial infarction (STEMI) is a critical condition requiring timely intervention.
- Percutaneous coronary intervention (PCI) is a primary treatment for STEMI.
- The duration of myocardial ischemia significantly impacts treatment outcomes and patient prognosis.
Purpose of the Study:
- To evaluate the impact of total myocardial ischemia time on treatment results in STEMI patients undergoing PCI.
- To identify factors associated with prolonged ischemia time.
- To assess the correlation between prehospital delay and total ischemia duration.
Main Methods:
- Retrospective analysis of a hospital PCI register for STEMI patients (2006-2017).
- Patients categorized into three groups based on total myocardial ischemia time: ≤180 min, 180-360 min, and >360 min.
- Comparison of mortality, major adverse cardiac events (MACE), and no-reflow phenomenon incidence across groups.
Main Results:
- Mortality and MACE rates were significantly lower in patients with ischemia time ≤180 min compared to longer durations.
- The no-reflow phenomenon incidence increased with ischemia time exceeding 360 min.
- Age, female gender, and chronic kidney disease were major predictors of ischemia time >180 min; prehospital thrombolysis reduced ischemia time.
Conclusions:
- Total myocardial ischemia time >180 min is associated with increased mortality and MACE in STEMI patients treated with PCI.
- Ischemia time >360 min is linked to a higher incidence of the no-reflow phenomenon.
- Prehospital delay significantly contributes to total ischemia time, emphasizing the need for rapid patient transport and treatment initiation.
Abstract:
Aim To evaluate the effect of the total time of myocardial ischemia on results of the treatment of patients with ST segment elevation acute myocardial infarction (STEMI) who underwent percutaneous coronary interventions (PCI).Material and methods This study used data from a hospital register for PCI in STEMI from 2006 through 2017. 1649 patients were included. Group 1 consisted of 604 (36.6 %) patients with a total time of myocardial ischemia not exceeding 1880 min; group 2 included 531 (32.2 %) patients with a duration of myocardial ischemia from 180 to 360 min; and group 3 included 514 (31.2 %) patients with a duration of myocardial ischemia longer than 360 min.Results Mortality was lower in group 1 (2.3 %) than in groups 2 and 3 (6.2 and 7.2 %, respectively; p1-2=0.001; p1-3<0.001; p2-3=0.520). The incidence of major cardiac complications ("adverse cardiac events", MACE) was lower in group 1 (4.1 %) than in groups 2 and 3 (7.3 and 9.5 %, respectively, p1-2=0.020; p1-3<0.001; p2-3=0.200). The incidence of no-reflow phenomenon was higher in group 3 (9.7 %) than in groups 2 and 3 (4.5 and 5.3 %, respectively (p1-2=0.539; p1-3=0.001; p2-3=0.005). The major factors associated with the increased total time of myocardial ischemia >180 min were age (odd ratio, OR, 1.01 at 95 % confidence interval, CI, 1.0 to 1.02; р=0.044), female gender (OR, 1.64 at 95 % CI 1.26 to 2.13; р<0.001), chronic kidney disease (OR 1.82 at 95 % CI 1.21 to 2.74; р=0.004). Performing prehospital thrombolysis was associated with a decrease in the total time of myocardial ischemia (OR 0.4 at 95 % CI 0.31 to 0.51; р<0.001). A strong direct correlation was observed between the total time of myocardial ischemia and the time from the onset of pain syndrome to hospitalization (r=0.759; р<0.001).Conclusion The total time of myocardial ischemia >180 min was associated with increased mortality and development of MACE. The total time of myocardial ischemia > 360 min was associated with increased incidence of the no-reflow phenomenon. The major predictors for the time of myocardial ischemia >180 min included age, female gender, and chronic kidney disease. The use of pharmacoinvasive strategy was associated with an increased number of patients with a total duration of myocardial ischemia <180 min. The contribution of the time of prehospital delay to the total time of myocardial ischemia was greater than the contribution of the "door-to-balloon" time. The time of prehospital delay showed a strong direct correlation with the total time of myocardial ischemia.
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