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Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction.
- Source :
-
Circulation. Cardiovascular interventions [Circ Cardiovasc Interv] 2018 Sep; Vol. 11 (9), pp. e006842. - Publication Year :
- 2018
-
Abstract
- Background: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting <12 hours.<br />Methods and Results: We included 865 STEMI patients who underwent cardiac magnetic resonance just after index PCI and 3 months later. Despite equal area at risk (34±12% versus 33±12%; P=0.370), patients presenting late (n=58) had larger final infarct size (13% [interquartile range, 9-24] versus 11% [interquartile range, 4-19]; P=0.037) and smaller myocardial salvage index (0.58 [interquartile range, 0.39-0.71] versus 0.65 [interquartile range, 0.49-0.84]; P=0.021) compared with patients presenting <12 hours after symptom onset (n=807). However, 65% of late-presenting patients achieved substantial myocardial salvage ≥0.50, and area under the curve for symptom onset to PCI as predictor of a myocardial salvage index ≥0.50 was poor (0.58 [95% CI, 0.53-0.63]; P<0.001). In addition, final infarct size, salvage index and left ventricular function correlated weakly with duration from symptom onset to primary PCI ( R <superscript>2</superscript> values <0.05).<br />Conclusions: STEMI patients with signs of ongoing ischemia treated with primary PCI 12 to 72 hours after symptom onset had less myocardial salvage and developed larger infarcts. However, a large proportion achieved substantial myocardial salvage indicating a benefit from primary PCI in late-presenting patients.<br />Clinical Trial Registration: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01435408 and NCT01960933.
- Subjects :
- Aged
Coronary Circulation
Female
Humans
Magnetic Resonance Imaging
Male
Middle Aged
Practice Guidelines as Topic
Prospective Studies
Risk Assessment
Risk Factors
ST Elevation Myocardial Infarction diagnostic imaging
ST Elevation Myocardial Infarction mortality
ST Elevation Myocardial Infarction physiopathology
Time Factors
Treatment Outcome
Percutaneous Coronary Intervention adverse effects
Percutaneous Coronary Intervention mortality
Percutaneous Coronary Intervention standards
ST Elevation Myocardial Infarction therapy
Time-to-Treatment standards
Subjects
Details
- Language :
- English
- ISSN :
- 1941-7632
- Volume :
- 11
- Issue :
- 9
- Database :
- MEDLINE
- Journal :
- Circulation. Cardiovascular interventions
- Publication Type :
- Academic Journal
- Accession number :
- 30354595
- Full Text :
- https://doi.org/10.1161/CIRCINTERVENTIONS.118.006842