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Clinical Trial
. 2018 Apr 1;39(13):1065-1074.
doi: 10.1093/eurheartj/ehy004.

Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial

Karl Heinrich Scholz  1 , Sebastian K G Maier  2 , Lars S Maier  3 , Björn Lengenfelder  4 , Claudius Jacobshagen  5 , Jens Jung  6 , Claus Fleischmann  7 , Gerald S Werner  8 , Hans G Olbrich  9 , Rainer Ott  10 , Harald Mudra  11 , Karlheinz Seidl  12 , P Christian Schulze  13 , Christian Weiss  14 , Josef Haimerl  15 , Tim Friede  16 , Thomas Meyer  17
Affiliations
Clinical Trial

Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial

Karl Heinrich Scholz et al. Eur Heart J. .

Abstract

Aims: The aim of this study was to investigate the effect of contact-to-balloon time on mortality in ST-segment elevation myocardial infarction (STEMI) patients with and without haemodynamic instability.

Methods and results: Using data from the prospective, multicentre Feedback Intervention and Treatment Times in ST-Elevation Myocardial Infarction (FITT-STEMI) trial, we assessed the prognostic relevance of first medical contact-to-balloon time in n = 12 675 STEMI patients who used emergency medical service transportation and were treated with primary percutaneous coronary intervention (PCI). Patients were stratified by cardiogenic shock (CS) and out-of-hospital cardiac arrest (OHCA). For patients treated within 60 to 180 min from the first medical contact, we found a nearly linear relationship between contact-to-balloon times and mortality in all four STEMI groups. In CS patients with no OHCA, every 10-min treatment delay resulted in 3.31 additional deaths in 100 PCI-treated patients. This treatment delay-related increase in mortality was significantly higher as compared to the two groups of OHCA patients with shock (2.09) and without shock (1.34), as well as to haemodynamically stable patients (0.34, P < 0.0001).

Conclusions: In patients with CS, the time elapsing from the first medical contact to primary PCI is a strong predictor of an adverse outcome. This patient group benefitted most from immediate PCI treatment, hence special efforts to shorten contact-to-balloon time should be applied in particular to these high-risk STEMI patients.

Clinical trial registration: NCT00794001.

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Figures

Figure 1
Figure 1
Flow diagram of patient cohort including the four groups of percutaneous coronary intervention-treated ST-segment elevation myocardial infarction patients as stratified by out-of-hospital cardiac arrest (OHCA) and cardiogenic shock (Shock).
Take home figure
Take home figure
In-hospital mortality of percutaneous coronary intervention-treated ST-segment elevation myocardial infarction patients by contact-to-balloon time. The figure displays the calculated probabilities of adverse outcome (coloured thick lines) from a logistic regression model with their corresponding 95% confidence intervals (dashes thin black lines) as stratified by the four groups of patients with and without cardiogenic shock (Shock) and out-of-hospital cardiac arrest (OHCA), respectively, including their interaction term.
Figure 2
Figure 2
Increase in mortality risk (in percentage points) in percutaneous coronary intervention-treated patients with a contact-to-balloon time (C2B) between 60 and 180 min resulting from a 10-min delay as shown for the four groups of study participants with and without out-of-hospital cardiac arrest (OHCA) and cardiogenic shock, respectively. The standard error for each bar is less than 0.02.
None
See this image and copyright information in PMC

Comment in

References

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