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Clinical Trial
. 2021 May;8(1):e001650.
doi: 10.1136/openhrt-2021-001650.

Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction

Karl Heinrich Scholz  1 , Thomas Meyer  2 , Björn Lengenfelder  3 , Christian Vahlhaus  4 , Jörn Tongers  5 , Steffen Schnupp  6 , Rainer Burckhard  7 , Nicolas von Beckerath  8 , Hans-Martin Grusnick  9 , Andreas Jeron  10 , Klaus Dieter Winter  11 , Sebastian K G Maier  12 , Michael Danner  13 , Jürgen Vom Dahl  14 , Stefan Neef  15 , Stefan Stefanow  16 , Tim Friede  17
Affiliations
Clinical Trial

Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction

Karl Heinrich Scholz et al. Open Heart. 2021 May.

Abstract

Background: In patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion.

Aims: To assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times.

Methods: A total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included.

Results: There were 1554 deaths (7.8%) with a J-shaped relationship between mortality and S2C time. Mortality was 10.0% in patients presenting within 1 hour, and 4.9%, 6.0% and 7.3% in patient groups with longer S2C intervals of 1-2 hours, 2-6 hours and 6-24 hours, respectively. Patients with a short S2C interval of less than 1 hour (S2C<60 min) had the highest survival benefit from timely reperfusion with PCI within 90 min (OR 0.27, 95% CI 0.23 to 0.31, p<0.0001) as compared with the three groups with longer S2C intervals of 1 hour<S2C≤2 hours (OR 0.44, 95% CI 0.33 to 0.59, p<0.0001), 2 hours<S2C≤6 hours (OR 0.49, 95% CI 0.38 to 0.64, p<0.0001) and 6 hours<S2C≤24 hours (OR 0.42, 95% CI 0.30 to 0.58, p<0.0001).

Conclusions: Timely reperfusion with a contact-to-balloon time of less than 90 min is most effective in patients presenting with short S2C intervals of less than 1 hour, but has also beneficial effects in patients with S2C intervals of up to 24 hours.

Trial registration number: NCT00794001.

Keywords: acute coronary syndrome; chest pain; myocardial infarction.

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Conflict of interest statement

Competing interests: TF reports personal fees for consultancies (including data monitoring committees) from Novartis, Bayer, Biogen, AstraZeneca, Janssen, Grünenthal, Pharmalog, SGS, Boehringer Ingelheim, Daiichi-Sankyo, Mediconomics and Roche, all outside the submitted work. Furthermore, he has received research funding by the European Commission for statistical analyses on the EUTrigTreat (NCT01209494) and EU-CERT-ICD (NCT02064192) clinical studies. All relationships declared are modest.

Figures

Figure 1
Figure 1
Flow diagram of the PCI-treated STEMI patients from the FITT-STEMI study population as stratified by four groups of symptom-onset-to-first-medical-contact times. FITT-STEMI, Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
In-hospital mortality of PCI-treated STEMI patients by different categories of time intervals from the symptom onset to the arrival of the EMS at the scene. (A) Depicted are the percentages of deaths among the four groups in the total study population (purple), in patients with a contact-to-balloon time of equal to or less than 90 min (green) or longer (red). (B) Mortality data as in (A) for the subgroup of STEMI patients who had not experienced out-of-hospital cardiac arrest (OHCA). EMI, emergency medical service; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction.
Figure 3
Figure 3
Odds ratios of mortality related to timely reperfusion as determined by a contact-to-balloon time of ≤90 min compared with >90 min and their corresponding 95% CI by categories of symptom-onset-to-first-medical contact time. Data are shown for the total study sample (A) and in the subgroup of patients without OHCA (B). OHCA, out-of-hospital cardiac arrest.
See this image and copyright information in PMC

References

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