Impact of the time to reperfusion on early outcomes in patients with acute myocardial infarction undergoing primary angioplasty.
BACKGROUND
The ACC/AHA guidelines for management of patients with ST-elevation myocardial infarction (STEMI) have recommended primary PCI (pPCI) as the preferred reperfusion therapy, when it can be performed in a timely fashion, within 90-110 min from the first contact with medical personnel. The impact of treatment delays on outcomes in patients undergoing pPCI has been controversial.


OBJECTIVE
To evaluate the impact of time delays on in-hospital mortality and on the frequency of cardiac events during 30 days after STEMI.


METHODS
1723 patients were stratified on the basis of their time delays: from symptom onset until balloon inflation. The patients were divided into 4 groups: group 1 (311 patients) - time from symptom onset <90 min; group 2 (731 patients) - time delays of 90-180 min; group 3 (535 patients) - time delays of 180-360 min, and group 4 (146 patients) - time from symptom onset >360 min.


RESULTS
The median time delay was 268.5+/-206 min, the median door to balloon time was 36.12+/-11.2 min. The patients with longer time delays (group 4) were older, more often were women, and had a higher frequency of diabetes, anterior MI and Killip class 4. During hospitalisation, 70 (4.1%) patients died. In-hospital mortality was significantly higher in group 4 (13.6%) than in other groups. Complications of STEMI such as cardiogenic shock considerably influenced mortality (45.6%). During a 30-day follow- -up, the patients with cardiogenic shock and the elderly had an increased risk of cardiac events. Also, time delays >360 min and failed pPTCA were independent adverse risk factors in multivariate regression analysis.


CONCLUSIONS
Delays in time to pPCI have an impact on outcomes, especially in those treated >6 hours from the onset of symptoms.
Second Chair and Department of Cardiology, Medical University, Łódź, Poland. ewa_trzos@op.pl
Ewa
E
Trzos
Małgorzata
M
Kurpesa
Zbigniew
Z
Bednarkiewicz
Jan
J
Peruga
Jarosław
J
Kasprzak
Michał
M
Plewka
Barbara
B
Uznańska
Maria
M
Krzemińska-Pakuła
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000517:prevention & control / Q000628:therapy*; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome