Primary coronary intervention in ST-elevation myocardial infarction

Area of Science:

• Cardiology
• Interventional Cardiology
• Emergency Medicine

Background:

• Timely reperfusion is critical for myocardial salvage in acute myocardial infarction (STEMI).
• Coronary intervention is the optimal strategy for vessel recanalization in STEMI patients.
• Elapsed ischemic time significantly impacts patient prognosis and life expectancy.

Purpose of the Study:

• To analyze changes in ischemic time components over five years for STEMI patients undergoing primary percutaneous coronary intervention (PCI).
• To evaluate shifts in reperfusion strategies and outcomes in STEMI treatment.
• To assess the impact of evolving treatment protocols on patient survival.

Main Methods:

• Retrospective analysis of 1663 STEMI patients treated with PCI between 2014 and 2018.
• Yearly breakdown of time intervals: symptom onset to first medical contact, first contact to interventional center admission, and admission to balloon angioplasty.
• Evaluation of 30-day mortality rates and device support utilization.

Main Results:

• Total ischemic time from symptom onset to balloon opening decreased significantly (median 5:29 to 4:07 hours, p=0.0001).
• Time to first medical contact and hospital admission shortened, but remained longer than ESC guidelines.
• Drug-eluting stent use increased from 15% to 96%; 30-day mortality showed a correlation with circulatory support needs.

Conclusions:

• While STEMI treatment times have improved, particularly hospital admission to reperfusion, pre-hospital delays persist.
• Achieving reperfusion within four hours occurred in approximately half of the patients.
• Expediting patient transfer to interventional centers is crucial for further improving outcomes in STEMI care.