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Impact of symptom-to-balloon time in patients with non-ST-segment elevation myocardial infarction and complex lesions
Yong Hoon Kim1, Ae-Young Her1, Seung-Woon Rha2
1Division of Cardiology, Department of Internal Medicine, Kangwon National University College of Medicine, Kangwon National University School of Medicine, Chuncheon.
Insights
Reducing symptom-to-balloon time (SBT) to under 48 hours significantly lowers 3-year mortality for non-ST-elevation myocardial infarction (NSTEMI) patients, especially those with complex lesions. This improves outcomes in NSTEMI care.
Area of Science:
- Cardiology
- Interventional Cardiology
- Clinical Outcomes Research
Background:
- Limited clinical outcome data exists for non-ST-elevation myocardial infarction (NSTEMI) patients.
- Percutaneous coronary intervention (PCI) with newer-generation drug-eluting stents is a common treatment for NSTEMI.
- Stratification by lesion complexity and symptom-to-balloon time (SBT) is crucial for understanding NSTEMI outcomes.
Purpose of the Study:
- To compare clinical outcomes of NSTEMI patients undergoing PCI with drug-eluting stents.
- To evaluate the impact of complex lesions and SBT (<48 hours vs. ≥48 hours) on NSTEMI patient outcomes.
- To identify optimal treatment strategies for improving survival and reducing adverse events in NSTEMI.
Main Methods:
- Analysis of 4373 NSTEMI patients from the Korea Acute Myocardial Infarction Registry-National Institute of Health.
- Stratification into complex (n=2106) and noncomplex (n=2267) groups based on lesion characteristics and SBT.
- Primary endpoint: 3-year all-cause mortality; Secondary endpoints: Major Adverse Cardiac Events (MACE), cardiac death, recurrent myocardial infarction, and stroke.
Main Results:
- SBT <48 hours was associated with significantly lower all-cause mortality, cardiac death, and MACE in the complex group.
- Patients with SBT <48 hours had lower mortality and MACE compared to those with SBT ≥48 hours, irrespective of lesion complexity.
- In the complex group, shorter SBT (<48 hours) reduced mortality and MACE, while stroke incidence was higher in the noncomplex group with shorter SBT.
Conclusions:
- Symptom-to-balloon time reduction to <48 hours is an effective strategy for decreasing 3-year mortality in NSTEMI patients, particularly those with complex lesions.
- Shorter SBT improves overall outcomes and reduces MACE in NSTEMI patients undergoing PCI.
- Timely intervention is critical for managing NSTEMI and improving patient prognosis.
Aims:
Considering the limited data regarding clinical outcomes of patients with non-ST-segment on the ECG elevation myocardial infarction (NSTEMI), this study compared the outcomes of patients undergoing percutaneous coronary intervention with newer-generation drug-eluting stents stratified by the presence/absence of complex lesions and symptom-to-balloon time (SBT; <48 h or ≥48 h).
Methods:
We enrolled 4373 patients with NSTEMI from the Korea Acute Myocardial Infarction Registry-National Institute of Health dataset and stratified them into the complex group (2106 patients; SBT < 48 h, n = 1365; SBT ≥48 h, n = 741) and the noncomplex group (2267 patients; SBT < 48 h, n = 1573; SBT ≥48 h, n = 694). The primary outcome was the 3-year all-cause mortality rate. The secondary outcomes were any major adverse cardiac events (MACE), including cardiac death (CD), recurrent myocardial infarction, and stroke.
Results:
The incidence of all-cause mortality (adjusted hazard ratio, 0.656; P = 0.009), CD ( P = 0.037), and MACE ( P = 0.047) in the complex group and of stroke in the noncomplex group ( P = 0.020) were significantly lower in patients with SBT < 48 h than in those with SBT ≥48 h. Among patients with SBT < 48 h, the stroke incidence ( P = 0.019) was higher in the complex group than in the noncomplex group, while among patients with SBT ≥48 h, the MACE incidence ( P = 0.011) was higher in the former than in the latter.
Conclusion:
SBT reduction effectively decreased the 3-year mortality in patients with NSTEMI in the complex group compared with the noncomplex group.
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