Key result
Prolonged total ischemic time was independently associated with higher in-hospital mortality in STEMI patients achieving optimal door-to-balloon times, with mortality risk increasing by 5% (OR 1.05) per hour of delay.
Why the study?
The significance of total ischemic time in STEMI remains controversial, prompting evaluation of its association with immediate outcomes when recommended door-to-balloon time under 90 minutes is achieved.
Does prolonged total ischemic time increase in-hospital mortality in STEMI patients who achieve optimal door-to-balloon times of ≤90 minutes?
Cohort (n=5,730)
No
Does prolonged total ischemic time increase in-hospital mortality in STEMI patients who achieve optimal door-to-balloon times of ≤90 minutes?
Odds Ratio: 1.05 (95% CI 1.02–1.07)
Absolute Event Rate: 7.8% vs 4.5%
p-value: p=<0.001
Prolonged total ischemic time is an independent predictor of in-hospital mortality in STEMI patients, highlighting the need to focus on reducing total ischemic time even when optimal door-to-balloon times are achieved.
Prolonged total ischemic time may raise STEMI mortality despite optimal door-to-balloon; hypothesis-generating for prehospital delay interventions.
BACKGROUND: Significance of total ischemic time (TIT) in the context of ST-segment elevation myocardial infarction (STEMI) is still controversial. Therefore, in this study, we have evaluate the association of TIT with immediate outcomes in STEMI patients in whom recommended door to balloon (DTB) time of less than 90 min was achieved. RESULTS: A total of 5730 patients were included in this study, out of which 80.9% were male and median age was 55 [61-48] years. The median DTB was observed to be 60 [75-45] min and onset of chest pain to emergency room (ER) arrival time was 180 [300-120] min. Prolonged TIT was associated with poor pre-procedure thrombolysis in myocardial infarction (TIMI) flow grade (p = 0.022), number of diseased vessels (p = 0.002), use of intra-aortic balloon pump (p = 0.003), and in-hospital mortality (p = 0.002). Mortality rate was 4.5%, 5.7%, and 7.8% for the patients with TIT of ≤ 120 min, 121 to 240 min, and > 240 min, respectively. Thirty days' risk of mortality on TIMI score was 4.97 ± 7.09%, 5.01 ± 6.99%, and 7.12 ± 8.64% for the patients with TIT of ≤ 120 min, 121 to 240 min, and > 240 min, respectively. CONCLUSIONS: Prolonged total ischemic was associated with higher in-hospital mortality. Therefore, TIT can also be considered in the matrix of focus, along with DTB time and other clinical determinants to improve the survival from STEMI.
No takes yet. Share an insight, caveat, or question.
Khowaja et al. (2021) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=5,730). Prolonged total ischemic time vs. Shorter total ischemic time (≤ 120 min) was evaluated on In-hospital mortality (OR 1.05, 95% CI 1.02-1.07, p=<0.001). Prolonged total ischemic time was independently associated with higher in-hospital mortality in STEMI patients achieving optimal door-to-balloon times, with mortality risk increasing by 5% (OR 1.05) per hour of delay.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: