title: Impact of delay to reperfusion on reperfusion success, infarct size, and clinical outcomes in patients with ST-segment elevation myocardial infarction: the INFUSE-AMI Trial (INFUSE-Anterior Myocardial Infarction).
abstract: OBJECTIVE
  Our aim was to study the impact of delay from symptom onset to first coronary device on infarct size and clinical outcomes at 30 days and 1 year in patients with ST-segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention.
  
  
  BACKGROUND
  Longer delay from symptom onset to reperfusion has been linked to increased mortality and worse clinical outcome. The mechanisms underpinning this association are not entirely clear.
  
  
  METHODS
  The INFUSE-AMI trial (INFUSE-Anterior Myocardial Infarction) randomized patients with anterior STEMI undergoing primary percutaneous coronary intervention with bivalirudin anticoagulation within 5 h of symptom onset to intralesion (IL) bolus abciximab versus no abciximab and to thrombus aspiration versus no aspiration. The primary endpoint was contrast magnetic resonance infarct size (IS) (percentage of left ventricular mass) at 30 days. Time to reperfusion was classified as <3 versus ≥3 h.
  
  
  RESULTS
  There were 280 patients (62%) with <3-h delay and 170 patients (38%) with ≥3-h delay. Patients with longer delay were significantly older, more often women, and diabetic. Earlier reperfusion was not associated with higher rates of final Thrombolysis In Myocardial Infarction flow grade 3 or myocardial blush grade 2/3, but was an independent predictor of smaller IS (p = 0.02 by multivariable linear regression). Mortality at 1 year was reduced in patients with shorter delay to reperfusion (4.0% vs. 9.2%, p = 0.02).
  
  
  CONCLUSIONS
  In patients with large anterior myocardial infarction undergoing relatively early reperfusion, longer delays to reperfusion were associated with larger IS and 1-year mortality, but not with reduced reperfusion success. (The INFUSE - Anterior Myocardial Infarction [AMI] Study; NCT00976521).
authors: Cardiovascular Research Foundation, New York, New York.
authors: Alejandra
authors: A
authors: Guerchicoff
authors: Cardiovascular Research Foundation, New York, New York; New York Methodist Hospital, Brooklyn, New York. Electronic address: sjb9005@nyp.org.
authors: Sorin J
authors: SJ
authors: Brener
authors: Cardiovascular Research Foundation, New York, New York.
authors: Akiko
authors: A
authors: Maehara
authors: Charité Campus Benjamin Franklin, Berlin, Germany.
authors: Bernhard
authors: B
authors: Witzenbichler
authors: Cardiovascular Research Foundation, New York, New York.
authors: Martin
authors: M
authors: Fahy
authors: Cardiovascular Research Foundation, New York, New York.
authors: Ke
authors: K
authors: Xu
authors: Mayo Clinic, Rochester, Minnesota.
authors: Bernard J
authors: BJ
authors: Gersh
authors: Cardiovascular Research Foundation, New York, New York; Mount Sinai Hospital, New York, New York.
authors: Roxana
authors: R
authors: Mehran
authors: Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
authors: C Michael
authors: CM
authors: Gibson
authors: Cardiovascular Research Foundation, New York, New York; Columbia University Medical Center, New York, New York.
authors: Gregg W
authors: GW
authors: Stone
mesh_terms: D000077284:Abciximab; D000368:Aged; D056988:Anterior Wall Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D000911:Antibodies, Monoclonal / Q000008:administration & dosage; D000991:Antithrombins / Q000008:administration & dosage; D016009:Chi-Square Distribution; D003326:Coronary Circulation; D005260:Female; D006629:Hirudins / Q000008:administration & dosage; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009206:Myocardium / Q000473:pathology*; D010446:Peptide Fragments / Q000008:administration & dosage; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011237:Predictive Value of Tests; D011994:Recombinant Proteins / Q000008:administration & dosage; D012307:Risk Factors; D013396:Suction; D017131:Thrombectomy / Q000379:methods; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D000991:Antithrombins; D006629:Hirudins; D007140:Immunoglobulin Fab Fragments; D010446:Peptide Fragments; D010975:Platelet Aggregation Inhibitors; D011994:Recombinant Proteins; C074619:bivalirudin; D000077284:Abciximab
keywords: STEMI; infarct size; ischemic time; myocardial blush grade; outcome