FACTORS INFLUENCING LATE PROGNOSIS IN PATIENTS WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION TREATED WITH
1Department of Emergency, Beijing Pinggu District Hospital, Beijing, China.
Insights
Reducing catheter laboratory activation time (CLAT) to 15 minutes significantly improves outcomes for ST-segment elevation myocardial infarction patients. Delayed activation, due to self-presentation or out-of-hours arrival, increases major adverse cardiovascular events (MACEs).
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- Direct percutaneous coronary intervention (PCI) is a primary treatment for ST-segment elevation myocardial infarction (STEMI).
- Timely reperfusion is critical for improving patient prognosis after STEMI.
- Factors influencing treatment delays and long-term outcomes in STEMI patients undergoing direct PCI require further investigation.
Purpose of the Study:
- To identify factors affecting the 2-year prognosis of STEMI patients treated with direct PCI.
- To evaluate the impact of catheter laboratory activation time (CLAT) on major adverse cardiovascular events (MACEs).
Main Methods:
- Retrospective analysis of 349 STEMI patients treated with direct PCI.
- Patients categorized by CLAT (≤15 min vs. >15 min), time of arrival (working hours vs. out-of-hours), and mode of arrival (emergency medical services vs. self-presentation).
- Primary endpoint: 2-year MACEs (all-cause death, nonfatal MI, target vessel revascularization).
Main Results:
- Patients with CLAT ≤15 min had significantly better outcomes and various clinical parameters.
- Self-presentation and out-of-hours presentation were identified as risk factors for CLAT >15 min.
- Significant differences observed in treatment times and MACE rates based on presentation mode and timing.
Conclusions:
- Achieving a CLAT of ≤15 minutes is associated with a significantly lower 2-year MACE rate in STEMI patients.
- Self-presentation and out-of-hours presentation are key risk factors contributing to delayed catheter laboratory activation.
- Optimizing patient arrival and activation protocols is crucial for improving STEMI management and patient prognosis.
Abstract:
Objective: To investigate factors influencing the late prognosis of patients with acute ST-segment elevation myocardial infarction treated by direct percutaneous coronary intervention. Methods: We retrospectively analyzed 349 ST-segment elevation myocardial infarction patients treated with direct percutaneous coronary intervention. Patients were categorized based on catheter laboratory activation time (CLAT) (≤15 or >15 min), time of arrival (working hours or out-of-hours), and mode of arrival (emergency medical services transportation or self-presentation). The primary endpoint was the 2-year major adverse cardiovascular events (MACEs), defined as all-cause death, nonfatal myocardial infarction, and target vessel revascularization. Results: Patients with CLAT ≤15 min showed significant differences in oxygen saturation, FMC-to-device time, symptom-to-device time, symptom-to-FMC time, presentation mode, presentation duration, and MACEs (all P < 0.005). Self-presentation (odds ratio = 0.593, 95% confidence interval = 0.413-0.759) and out-of-hours presentation (odds ratio = 0.612, 95% confidence interval = 0.433-0.813) were risk factors for CLAT >15 min. The working-hours group showed significant differences in FMC-to-device time, activation-to-arrival time at the catheter laboratory, and the number of cases with activation time ≤15 min (all P < 0.005). The emergency medical services and self-presentation groups differed significantly in age, blood pressure, FMC-to-device time, and electrocardiography-to-CLAT (all P < 0.005). Conclusion: Reducing CLAT to 15 min significantly lowers the 2-year MACE rate. Self-presentation and out-of-hours presentation are risk factors for delayed catheter laboratory activation.
