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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Clinical characteristics and outcomes of Australian and Indian ST-segment elevation myocardial infarction (STEMI)
M L Savage1, K Hay2, H Sundar3
1Cardiology Department, The Prince Charles Hospital, Brisbane, QLD, Australia; School of Clinical Medicine, Faculty of Medicine, University of Queensland, Brisbane, QLD, Australia.
Insights
Indian patients with ST-elevation myocardial infarction (STEMI) presented younger and with more comorbidities, yet achieved faster in-hospital reperfusion times. Despite longer pre-hospital delays and lower post-procedure blood flow, 30-day and 1-year mortality rates were similar to Australian patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- ST-elevation myocardial infarction (STEMI) incidence and mortality are higher in Indian populations.
- Limited comparative data exists on contemporary primary percutaneous coronary intervention (pPCI) for STEMI between developed and developing nations.
Purpose of the Study:
- To compare demographics, treatment strategies, and clinical outcomes of STEMI patients treated with pPCI in India and Australia.
- To identify differences in reperfusion times and mortality between the two cohorts.
Main Methods:
- A retrospective study comparing STEMI patients treated with pPCI at tertiary centers in India and Australia from January 2017 to December 2019.
- Data collected included patient demographics, procedural characteristics, times to reperfusion, and mortality.
Main Results:
- Indian patients were younger, more likely male, and had higher rates of diabetes and lower BMI compared to Australian patients.
- Indian patients experienced significantly longer symptom-to-balloon times but shorter door-to-balloon times.
- Achieved TIMI III flow post-PCI was lower in Indian patients, but 30-day and 1-year mortality rates were not significantly different.
Conclusions:
- Significant demographic and presentation differences exist between Indian and Australian STEMI patients undergoing pPCI.
- Indian patients face longer pre-hospital delays and lower post-PCI flow, despite shorter in-hospital treatment times, with comparable mortality outcomes.
Introduction:
The incidence of STEMI and subsequent mortality has been reported to be higher in Indian populations compared to developed countries. However, there is limited data directly comparing contemporary primary percutaneous coronary intervention (pPCI) treatment strategies and clinical outcomes for STEMI patients between developed and developing countries.
Materials And Methods:
We compared population demographics, procedural characteristics, times to reperfusion and mortality in STEMI patients treated with pPCI between two tertiary referral centers in India and Australia respectively over a 3-year period (1st Jan 2017-31st Dec 2019).
Results:
A total of 1293 STEMI presentations (896 Indian vs 397 Australian) were included. On average, Indian patients had lower median BMI than Australian patients (BMI 25.4 vs 27.8; p < 0.001), were significantly younger (mean age 56.0 vs 63.2 years; p < 0.001), more likely male (84 % vs 80 %; p = 0.046) and diabetic (48 % vs 18 %); p < 0.001). Radial access (50 % vs 88 %; p < 0.001) and TIMI III flow post PCI was also significantly lower (85 % vs 96 %; p < 0.001) with median door-to-balloon time significantly shorter in the Indian cohort (20mins vs 43mins; p < 0.001); however, median symptom to balloon time was significantly longer (245mins vs 160mins; p < 0.001). No significant differences in 30-day mortality (4.0 % vs 2.8 % Australian; p = 0.209) or 1-year mortality (6.5 % vs 4.3 %; p = 0.120) were observed.
Conclusion:
Significant differences in demographics and presentation characteristics exist between Indian and Australian STEMI patients treated with pPCI. Indian patients had significantly longer pre-hospital delays and lower achievement of TIMI III flow post PCI, yet shorter in-hospital time to treatment.
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