Does an ECG-to-wire delay >120 minutes worsen infarct size, myocardial salvage, and clinical outcomes in STEMI patients treated with primary PCI?
In STEMI patients undergoing primary PCI, an ECG-to-wire delay >120 minutes is associated with larger infarct size, reduced myocardial salvage, and higher risk of mortality and heart failure, reinforcing the need for rapid reperfusion.
AIMS: We aimed to evaluate the impact of delay from diagnostic pre-hospital electrocardiogram (ECG) to wiring of the infarct-related vessel (ECG-to-wire) >120 minutes on cardiovascular magnetic resonance (CMR) markers of reperfusion success and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). METHODS AND RESULTS: We included 1,492 patients in the analyses of clinical outcome. CMR was performed in 748 patients to evaluate infarct size and myocardial salvage. In total, 304 patients (20%) had ECG-to-wire >120 minutes, which was associated with larger acute infarct size (18% interquartile range (IQR), 10-28 vs. 15% 8-24; p=0.022) and smaller myocardial salvage (0.42 IQR 0.28-0.57 vs. 0.50 IQR 0.34-0.70; p=0.002). However, 33% of the patients with ECG-to-wire >120 minutes still had a substantial myocardial salvage ≥0.50. In a multivariable analysis, ECG-to-wire >120 minutes was associated with an increased risk of all-cause mortality and heart failure (hazard ratio 1.61, 95% confidence interval CI 1.14-2.26, p=0.007). CONCLUSIONS: ECG-to-wire >120 minutes was associated with larger infarct size, smaller myocardial salvage and a poorer clinical outcome in STEMI patients transferred for primary percutaneous coronary intervention. However, myocardial salvage was still substantial in one third of patients treated beyond 120 minutes of delay.
Nepper‐Christensen et al. (Wed,) studied this question.