RT Journal Article
SR Electronic
T1 Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction
JF Open Heart
JO Open Heart
FD British Cardiovascular Society
SP e001650
DO 10.1136/openhrt-2021-001650
VO 8
IS 1
A1 Karl Heinrich Scholz
A1 Thomas Meyer
A1 Björn Lengenfelder
A1 Christian Vahlhaus
A1 Jörn Tongers
A1 Steffen Schnupp
A1 Rainer Burckhard
A1 Nicolas von Beckerath
A1 Hans-Martin Grusnick
A1 Andreas Jeron
A1 Klaus Dieter Winter
A1 Sebastian K G Maier
A1 Michael Danner
A1 Jürgen vom Dahl
A1 Stefan Neef
A1 Stefan Stefanow
A1 Tim Friede
YR 2021
UL http://openheart.bmj.com/content/8/1/e001650.abstract
AB Background In patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion.Aims To assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times.Methods A total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included.Results There were 1554 deaths (7.8%) with a J-shaped relationship between mortality and S2C time. Mortality was 10.0% in patients presenting within 1 hour, and 4.9%, 6.0% and 7.3% in patient groups with longer S2C intervals of 1–2 hours, 2–6 hours and 6–24 hours, respectively. Patients with a short S2C interval of less than 1 hour (S2C<60 min) had the highest survival benefit from timely reperfusion with PCI within 90 min (OR 0.27, 95% CI 0.23 to 0.31, p<0.0001) as compared with the three groups with longer S2C intervals of 1 hour<S2C≤2 hours (OR 0.44, 95% CI 0.33 to 0.59, p<0.0001), 2 hours<S2C≤6 hours (OR 0.49, 95% CI 0.38 to 0.64, p<0.0001) and 6 hours<S2C≤24 hours (OR 0.42, 95% CI 0.30 to 0.58, p<0.0001).Conclusions Timely reperfusion with a contact-to-balloon time of less than 90 min is most effective in patients presenting with short S2C intervals of less than 1 hour, but has also beneficial effects in patients with S2C intervals of up to 24 hours.Trial registration number NCT00794001.All data relevant to the study are included in the article and are available on reasonable request from the last author (TF).