Coronary artery diseaseQuantitative Analysis of the Impact of Total Ischemic Time on Myocardial Perfusion and Clinical Outcome in Patients With ST-Elevation Myocardial Infarction
Section snippets
Methods
We performed an analysis of ischemic time data from consecutive patients with STEMI presenting to the University Medical Center of Groningen from January 2005 to July 2008. Inclusion criteria were symptoms of chest pain suggestive of acute myocardial infarction lasting ≥30 minutes and <24 hours before hospital admission, electrocardiographic findings of ST-segment elevation >0.1 mV in ≥2 leads, and the performance of a primary PCI procedure. Exclusion criteria were the presence of cardiogenic
Results
From January 2005 to July 2008, 1,731 consecutive patients with STEMI were treated with primary PCI at our hospital (Figure 1). Ischemic time was available in 1,383 patients, (79.9%) of all 1731 STEMI patients. Of these, 255 patients (18.4%) had ischemic times ≤2 hours, 432 patients (31.2%) ad times >2 to 3 hours, 371 patients (26.8%) had times >3 to 5 hours, and 325 patients (23.5%) had times >5 hours. The median ischemic time was 3.1 hours (interquartile range 2.3 to 4.8). As listed in Table 1
Discussion
In this contemporary cohort of patients with STEMI treated with primary PCI, thrombus aspiration, and triple-antiplatelet therapy, myocardial reperfusion, as assessed by angiography (MBG of 3) and electrocardiography (ST-segment resolution >70%), was better in patients with total ischemic times ≤5 hours than in those with longer ischemic times. Interestingly, if ischemic time can be limited to ≤5 hours, the duration of ischemia seems to only modestly influence myocardial reperfusion. Most
References (29)
- et al.
Impact of primary coronary angioplasty delay on myocardial salvage, infarct size, and microvascular damage in patients with ST-segment elevation myocardial infarction: insight from cardiovascular magnetic resonance
J Am Coll Cardiol
(2009) - et al.
Duration of ischemia is a major determinant of transmurality and severe microvascular obstruction after primary angioplasty: a study performed with contrast-enhanced magnetic resonance
J Am Coll Cardiol
(2005) - et al.
Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction
J Am Coll Cardiol
(1998) - et al.
Impact of time to treatment on myocardial reperfusion and infarct size with primary percutaneous coronary intervention for acute myocardial infarction (from the EMERALD trial)
Am J Cardiol
(2007) - et al.
A randomized trial comparing primary infarct artery stenting with or without abciximab in acute myocardial infarction
J Am Coll Cardiol
(2003) - et al.
Intracoronary thrombus: role in coronary occlusion complicating percutaneous transluminal coronary angioplasty
J Am Coll Cardiol
(1985) - et al.
Clinical value of 12-lead electrocardiogram after successful reperfusion therapy for acute myocardial infarction
Lancet
(1997) - et al.
Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty
J Am Coll Cardiol
(2003) - et al.
Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour
Lancet
(1996) - et al.
Reperfusion by primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction within 12 to 24 hours of the onset of symptoms (from a prospective national observational study [PL-ACS])
Am J Cardiol
(2011)
Feasibility and safety of prehospital administration of bivalirudin in patients with ST-elevation myocardial infarction
Am J Cardiol
Randomized comparison of eptifibatide versus abciximab in primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: results of the EVA-AMI trial
J Am Coll Cardiol
Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial
Lancet
The wavefront phenomenon of ischemic cell death1. Myocardial infarct size vs duration of coronary occlusion in dogs
Circulation
Cited by (22)
Prognostic value and clinical usefulness of PIANO score in patients undergoing primary percutaneous coronary intervention
2023, International Journal of CardiologyTotal ischemic time and age as predictors of PCI failure in STEMIs: A systematic review
2023, American Journal of the Medical SciencesDeterminants of total ischemic time in primary percutaneous coronary interventions: A prospective analysis
2018, Indian Heart JournalCitation Excerpt :Longer ischemic times are associated with increase in microvascular obstruction, which further increases the infarct size. The total ischemic time, measured from symptom onset to the provision of reperfusion therapy is thus of significant importance for the outcomes of patients with STEMI.5 There are fewer studies which assessed the factors that cause longer total ischemic time.6
Symptom-to-Balloon Time is a Strong Predictor of Adverse Events Following Primary Percutaneous Coronary Intervention: Results From the Australian Capital Territory PCI Registry
2017, Heart Lung and CirculationCitation Excerpt :One study indicated that 32.6% of patients over 70 years experienced atypical symptoms which were captured in a timely manner only on account of home telecardiography [21]. The presence of diabetes prolonged symptom to FMC time by a median of 35 minutes in our cohort, in keeping with other reports [22,23]. In a large study from the US, adjusted delays in presentation were 19 minutes longer for those aged 70–79 compared to those aged 60 years and under, and 18 minutes longer for diabetics [15].