open access

Vol 65, No 11 (2007)
Other
Published online: 2007-11-21
Submitted: 2012-12-28
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Original article
Impact of the time to reperfusion on early outcomes in patients with acute myocardial infarction undergoing primary angioplasty

Ewa Trzos, Małgorzata Kurpesa, Zbigniew Bednarkiewicz, Jan Peruga, Jarosław Kasprzak, Michał Plewka, Barbara Uznańska, Maria Krzemińska-Pakuła
Kardiol Pol 2007;65(11):1296-1304.

open access

Vol 65, No 11 (2007)
Other
Published online: 2007-11-21
Submitted: 2012-12-28

Abstract


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.
Aim: 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 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.
Conclusion: Delays in time to pPCI have an impact on outcomes, especially in those treated >6 hours from the onset of symptoms.

Abstract


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.
Aim: 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 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.
Conclusion: Delays in time to pPCI have an impact on outcomes, especially in those treated >6 hours from the onset of symptoms.
Get Citation

Keywords

myocardial infarction; primary angioplasty; prognosis

About this article
Title

Original article
Impact of the time to reperfusion on early outcomes in patients with acute myocardial infarction undergoing primary angioplasty

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Vol 65, No 11 (2007)

Pages

1296-1304

Published online

2007-11-21

Bibliographic record

Kardiol Pol 2007;65(11):1296-1304.

Keywords

myocardial infarction
primary angioplasty
prognosis

Authors

Ewa Trzos
Małgorzata Kurpesa
Zbigniew Bednarkiewicz
Jan Peruga
Jarosław Kasprzak
Michał Plewka
Barbara Uznańska
Maria Krzemińska-Pakuła

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