Back to Search
Start Over
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)
- Source :
- JACC. Cardiovascular interventions. 7(7)
- Publication Year :
- 2013
-
Abstract
- 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.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.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 as3 versus ≥3 h.There were 280 patients (62%) with3-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).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).
- Subjects :
- Male
Time Factors
Abciximab
Kaplan-Meier Estimate
Suction
Antithrombins
Time-to-Treatment
Immunoglobulin Fab Fragments
Percutaneous Coronary Intervention
Predictive Value of Tests
Risk Factors
Coronary Circulation
Humans
Anterior Wall Myocardial Infarction
Aged
Thrombectomy
Chi-Square Distribution
Myocardium
Antibodies, Monoclonal
Hirudins
Middle Aged
Magnetic Resonance Imaging
Peptide Fragments
Recombinant Proteins
United States
Treatment Outcome
Multivariate Analysis
Linear Models
Female
Platelet Aggregation Inhibitors
Subjects
Details
- ISSN :
- 18767605
- Volume :
- 7
- Issue :
- 7
- Database :
- OpenAIRE
- Journal :
- JACC. Cardiovascular interventions
- Accession number :
- edsair.pmid..........ff9c1280440420711073669876648c17