Relationship between primary percutaneous coronary intervention time of day, infarct size, microvascular obstruction
Shmuel Chen1,2, Björn Redfors1,2,3, Aaron Crowley1
1Clinical Trials Center, Cardiovascular Research Foundation.
Insights
The time of day for primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction (STEMI) patients does not impact infarct size, microvascular obstruction, or long-term prognosis. This finding is based on a large pooled analysis of individual patient data.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Imaging
Background:
- Uncertainty exists regarding the impact of percutaneous coronary intervention (pPCI) timing on ST-segment elevation myocardial infarction (STEMI) outcomes.
- Key outcomes include infarct size, microvascular obstruction (MVO), and patient prognosis.
Purpose of the Study:
- To investigate the association between the time of day of pPCI and infarct size, MVO, and clinical prognosis in STEMI patients.
- Utilized a large, individual patient-data pooled database for comprehensive analysis.
Main Methods:
- Pooled data from five randomized pPCI trials with cardiac MRI (CMR) for infarct size assessment.
- Patients were categorized based on the time of day their pPCI was performed.
- Infarct size, MVO, and 1-year clinical outcomes were analyzed in relation to pPCI timing.
Main Results:
- No significant difference in infarct size was observed across different pPCI time-of-day groups (morning, afternoon, overnight).
- The time of day of pPCI was not associated with microvascular obstruction (MVO).
- One-year risks of death or heart failure hospitalization were similar regardless of pPCI timing.
Conclusions:
- The time of day for pPCI in STEMI patients is not associated with infarct size.
- pPCI timing does not influence microvascular obstruction or prognosis after STEMI.
- Findings are based on a large-scale pooled analysis of individual patient data.
Background:
Whether the time of day of primary percutaneous coronary intervention (pPCI) in patients with ST-segment elevation myocardial infarction (STEMI) is associated with infarct size, microvascular obstruction (MVO), and prognosis is uncertain. We compared infarct size assessed by cardiac MRI (CMR) and clinical outcomes in STEMI patients according to the pPCI time of day from a large, individual patient-data pooled database.
Methods:
We pooled patient-level data from five randomized pPCI trials in which infarct size was measured within 1 month by CMR. Patients were categorized according to the pPCI time of day.
Results:
Among 1519 patients with STEMI, 794 (52.2%) underwent pPCI between 8:00 h and 15:59 h, 431 (28.4%) between 16:00 h and 23:59 h, and 294 (19.4%) between 24:00 h and 7:59 h. Infarct size was assessed in 1331 patients at a median of 3.0 days (interquartile range 2.0-5.0) after pPCI. Compared with patients who underwent PCI between 8:00 h and 15:59 h, infarct size was not significantly different for patients undergoing PCI from 16:00 h to 23:59 h [adjusted difference -0.7%, 95% confidence interval (CI) -3.1 to 1.7%, P = 0.46] or 24:00 h to 7:59 h (adjusted difference 0.9%, 95% CI -1.2 to 3.1%, P = 0.29). The time of day of pPCI was also unrelated to MVO and the 1-year risks of death or heart failure hospitalization.
Conclusion:
In this large-scale, individual patient data pooled analysis, no association was found between the time of day of pPCI and infarct size, MVO, or prognosis after STEMI.
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