Clinical InvestigationCongestive Heart FailureImpact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction
Section snippets
Study population
The patients in the present substudy participated in a randomized study comparing intravenous administration of exenatide with placebo in patients with STEMI.24 In that previous study, patients with STEMI were randomized to receive either exenatide or placebo saline intravenously 15 minutes before intervention. This treatment resulted in increased myocardial salvage index in the exenatide group (for more details, see Ref. [24]). The patients were randomized before angiography, and some
Results
In a total of 219 patients with STEMI infarct size measured by CMR, system and prehospital delay times were available (Figure 2). Area at risk could not be measured in 26 patients; thus myocardial salvage index was available in 193 patients (Figure 2). The baseline characteristic of the study population is shown in Table I. Unfortunately, because of logistics and clinical condition, it was not possible to perform a CMR in all patients within 1 week. Eighty-four percent of the patients had their
Discussion
The main finding of our study was an independent association of both system- and prehospital delay with myocardial salvage index and infarct size. In particular, system delay of <121 minutes was associated with reduced myocardial damage and improved LV function. Thus, larger myocardial damage may partly explain the previously observed association between longer system delay and increased mortality.19
The benefit in terms of myocardial salvage and infarct size with early reperfusion therapy has
Conclusions
A shorter system delay resulted in smaller infarct size, larger myocardial salvage index, and improved LV function in patients treated with primary PCI. Thus, this study confirms that minimizing system delay is crucial for primary PCI–related benefits.
Acknowledgements
We thank research study nurses Lene Kløvgaard, Bettina Løjmand, and Bente Andersen, and the entire staff of the Department of Cardiology at Copenhagen University Hospital, Rigshospitalet, for skilful assistance.
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