Contemporary Implications of ECG to Activation Time on Long-term Outcomes in Patients With ST-Segment Elevation
Hui Gao1, Hui Peng1, Zhijun Sun1
1Department of Cardiology, Cardiovascular Center, Beijing Friendship Hospital, Capital Medical University, Beijing, People's Republic of China.
Insights
Reducing ECG to activation time (EAT) is crucial for improving outcomes in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PPCI). Shorter EAT is linked to fewer major adverse cardiovascular events (MACEs).
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Door to balloon time (DBT) is a critical prognostic factor for ST-segment elevation myocardial infarction (STEMI) patients.
- The ECG to activation time (EAT) is a key component of DBT, but its impact on long-term outcomes is less understood.
- Contemporary data on the association between EAT and major adverse cardiovascular events (MACEs) in STEMI patients undergoing primary percutaneous coronary intervention (PPCI) is needed.
Purpose of the Study:
- To evaluate the association between ECG to activation time (EAT) and major adverse cardiovascular events (MACEs) in STEMI patients undergoing PPCI.
- To investigate factors influencing EAT in patients with STEMI undergoing PPCI.
- To determine if EAT impacts long-term clinical outcomes in a contemporary STEMI population.
Main Methods:
- A total of 1082 consecutive STEMI patients undergoing PPCI between 2013 and 2019 were analyzed.
- Patients were stratified into three groups based on EAT: ≤30 minutes, 30-60 minutes, and >60 minutes.
- The incidence of MACEs (all-cause death, nonfatal MI, nonfatal stroke) was assessed over a median follow-up of 37 months.
Main Results:
- Median EAT was 58 minutes, strongly correlating with DBT (r=0.95) and explaining 90% of its variability.
- An EAT ≤30 minutes yielded a 94.1% chance of achieving a DBT ≤90 minutes.
- Increased EAT was associated with a higher incidence of MACEs (10.2% for EAT ≤30 min to 17.3% for EAT >60 min) and mortality, with EAT >30 minutes independently predicting long-term MACEs (HR=1.99).
Conclusions:
- Achieving an EAT ≤30 minutes is crucial for meeting guideline-recommended DBT targets in current practice.
- Delayed EAT (>30 minutes) is a significant driver of DBT and is independently associated with worse long-term clinical outcomes in STEMI patients.
- Minimizing EAT through strategies addressing factors like critical illness and consent for revascularization is essential for reducing long-term MACEs in STEMI patients.
Purpose:
The prognosis of door to balloon time (DBT) after primary percutaneous coronary intervention (PPCI) in ST-segment elevation myocardial infarction (STEMI) has been extensively studied. However, the clinical implications of the ECG to activation time (EAT), as a component of DBT, on long-term outcomes are less well established. This study evaluates the association of EAT with major adverse cardiovascular events (MACEs) in more contemporary patients undergoing PPCI and investigates factors that influence EAT.
Methods:
A total of 1082 consecutive patients with STEMI who underwent PPCI from 2013 to 2019 were classified into 3 groups according to EAT: EAT ≤30 minutes, EAT of 30 to 60 minutes, and EAT >60 minutes. We analyzed the incidence of MACEs, including all-cause death, nonfatal recurrence of MI, or nonfatal stroke during a median follow-up of 37 months.
Findings:
The median EAT was 58 minutes (interquartile range, 44-80 minutes), which explained 90% of the variability in DBT and had the strongest correlation with DBT (r = 0.95, P < 0.001). Achieving an EAT of ≤30 minutes resulted in a 94.1% chance of achieving a DBT ≤90 minutes. The incidence of MACEs had a concurrent increase with increased EAT (10.2% for EAT ≤30 minutes, 14.3% for EAT of 30-60 minutes, and 17.3% for EAT >60 minutes; P = 0.027) that was driven by more mortality (4.2% for EAT ≤30 minutes, 6.9% for EAT of 30-60 minutes, and 9.8% for EAT >60 minutes; P = 0.020). An EAT >30 minutes was independently associated with risk-adjusted long-term MACEs (hazard ratio = 1.99; 95% CI, 1.07-3.69; P = 0.030). Critically ill status in emergency department (P = 0.001) and time required for consent of revascularization (P < 0.001) were significantly associated with delayed EAT.
Implications:
Achieving an EAT ≤30 minutes was key to achieving the guideline-recommended target time of DBT in contemporary practice. As a strong driver of overall DBT, EAT >30 minutes was associated with worse clinical outcome in patients with STEMI undergoing PPCI. These data suggest that efforts to minimize EAT are needed to reduce long-term MACEs in contemporary population. © 2021 Elsevier HS Journals, Inc.
More Related Videos
10:17Real-Time Cardiac Mapping with a Noninvasive Imageless Electrocardiographic Imaging System
Published on: April 11, 2025
05:41Left Anterior Descending Coronary Artery Ligation for Ischemia-Reperfusion Research: Model Improvement via Technical Modifications and Quality Control
Published on: December 16, 2022
Related Concept Videos
01:30Acute Coronary Syndrome I: Introduction
01:29Electrocardiogram
Three major waveforms are present in a typical ECG recording: the P wave, the QRS complex, and...
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:19Acute Coronary Syndrome II: Pathophysiology and Clinical Manifestations
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Cardiac Action Potential
The cardiac action potential process involves a series of phases characterized by the movement of ions across the cardiac cell membranes, leading to the depolarization and repolarization of the cardiac myocytes.
Ionic Basis of Cardiac Action Potentials