Key result
Prolonged time-to-treatment in STEMI is linked to impaired ST-segment resolution.
Why the study?
The prognostic role of time-to-treatment in primary angioplasty remained a matter of debate.
Does prolonged time-to-treatment impair myocardial perfusion and clinical outcomes in patients with STEMI treated by primary angioplasty?
Cohort (n=1,072)
Does prolonged time-to-treatment impair myocardial perfusion and clinical outcomes in patients with STEMI treated by primary angioplasty?
Prolonged ischemic time in STEMI patients undergoing primary angioplasty is significantly associated with impaired myocardial perfusion, larger infarct size, and higher 1-year mortality.
Answers are grounded in this paper and cite their sources.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In the study by De Luca et al., reperfusion was evaluated by the use of ST-segment resolution and myocardial blush in patients with STEMI, treated with primary PCI. They observed a clear and significant relationship between age and reperfusion even after adjustment for baseline confounding factors. Because myocardial perfusion is strongly associated with survival, this is an important observation.”
Prolonged time-to-treatment was associated with impaired perfusion; leaves open whether faster reperfusion improves outcomes beyond current door-to-balloon targets.
AIMS: The prognostic role of time-to-treatment in primary angioplasty is still a matter of debate. The aim of our study was to evaluate the relationship between time-to-treatment and myocardial perfusion in patients with ST-segment-elevation myocardial infarction (STEMI) treated by primary angioplasty. METHODS AND RESULTS: Our study population consisted of 1072 patients with STEMI treated by primary angioplasty from 1997 to 2001. Myocardial perfusion was evaluated by using ST-segment resolution and myocardial blush grade. Time-to-treatment was defined as the time from symptom-onset to the first balloon inflation. Time-to-treatment was significantly associated with the extent of ST-segment resolution, myocardial blush grade, enzymatic infarct size, and 1-year mortality. After adjustment for baseline confounding factors, time-to-treatment was still associated with impaired ST-segment resolution (adjusted OR [95% CI]=1.01 [1.01-1.02], p<0.001) and myocardial blush (adjusted OR [95% CI]=1.01 [1.01-1.02], p<0.0001). CONCLUSIONS: This study shows that in patients with STEMI treated by primary angioplasty prolonged ischaemic time is associated with impaired myocardial perfusion, larger infarct size, and higher 1-year mortality. Therefore, all efforts should be made to shorten ischaemic time as much as possible to achieve better myocardial perfusion and myocardial salvage in primary angioplasty for STEMI.
No takes yet. Share an insight, caveat, or question.
A 2004 study conducted a cohort in ST-segment-elevation myocardial infarction (STEMI) (n=1,072). Time-to-treatment was evaluated on Impaired ST-segment resolution (OR 1.01, 95% CI 1.01-1.02, p=<0.001). Prolonged time-to-treatment in STEMI patients undergoing primary angioplasty was significantly associated with impaired ST-segment resolution (OR 1.01; 95% CI 1.01-1.02; P<0.001).
Synapse has enriched 10 related papers. Consider them for comparative context: