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. 2023 Jun;16(6):e012810.
doi: 10.1161/CIRCINTERVENTIONS.122.012810. Epub 2023 Jun 20.

Reperfusion Delays and Outcomes Among Patients With ST-Segment-Elevation Myocardial Infarction With and Without Cardiogenic Shock

Andrew Kochan  1 , Terry Lee  2 , Nima Moghaddam  3 , Grace Milley  3 , Joel Singer  2 , John A Cairns  1 , Graham C Wong  1 , Jacob C Jentzer  4 , Sean van Diepen  5 , Carlos Alviar  6 , Christopher B Fordyce  1
Affiliations

Reperfusion Delays and Outcomes Among Patients With ST-Segment-Elevation Myocardial Infarction With and Without Cardiogenic Shock

Andrew Kochan et al. Circ Cardiovasc Interv. 2023 Jun.

Abstract

Background: Mortality remains high in patients with ST-segment-elevation myocardial infarction (STEMI) complicated by cardiogenic shock (CS), and early reperfusion has been shown to improve outcomes. We analyzed the association between first medical contact (FMC)-to-percutaneous coronary angiography time with mortality and major adverse cardiovascular events among patients with STEMI with and without CS.

Methods: We performed a retrospective analysis of the Vancouver Coastal Health Authority STEMI registry, including all patients with STEMI who received primary percutaneous coronary angiography between January 1, 2010, and December 31, 2020, and stratified them by presence or absence of CS at hospital arrival. The primary outcome was in-hospital mortality, the secondary outcome was in-hospital major adverse cardiovascular events, defined as a composite of the first occurrence of mortality, cardiac arrest, heart failure, intracerebral hemorrhage, cerebrovascular accident, or reinfarction. Mixed effects logistic regression with restricted cubic splines was used to estimate the relationships between FMC-to-device time and the outcomes in the CS and non-CS groups.

Results: 2929 patients were included, 9.4% (n=275) had CS. Median FMC-to-device time was 113.5 (interquartile range, 93.0-145.0) and 103.0 (interquartile range, 85.0-130.0) minutes for patients with CS and without CS, respectively. More patients with CS had FMC-to-device times above guideline recommendations (76.6% versus 54.1%, P<0.001). Between 60 and 90 minutes, for each 10-minute increase in FMC-to-device time, absolute mortality for patients with CS increased by 4% to 7%, whereas for patients without CS, it increased by <0.5%.

Conclusions: Among patients with STEMI undergoing primary percutaneous coronary angiography, reperfusion delays among patients with CS are associated with significantly worse outcomes. Strategies to reduce FMC-to-device times for patients with STEMI presenting with CS are required.

Keywords: mortality; myocardial infarction; percutaneous coronary intervention.

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Conflict of interest statement

Disclosures Dr Fordyce serves on advisory boards for Bayer, Novo Nordisk, Boehringer Ingelheim, and Sanofi. Dr Cairns has received research grant support from Medtronic, Sanofi Aventis, AstraZeneca, Bayer, Boston Scientific, and Edwards Laboratories; has received speaker honoraria from Pfizer/Bristol Myers Squibb (BMS), Bayer, Servier; has received consulting fees from St Jude Medical, Bayer, BMS, Servier; Data and Safety Monitoring Boards; ARTESiA ([Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation] apixaban; Canadian Institutes of Health Research [CIHR], BMS), COMPASS ([Cardiovascular Outcomes for People Using Anticoagulation Strategies] rivaroxaban; Bayer); and ATLAS- ICD ([Avoid Transvenous Leads in Appropriate Subjects Implantable Cardiac Defibrillator]; CIHR, Boston Scientific), OCEAN ([The Optimal Anti-Coagulation for Enhanced-Risk Patients Post-Catheter Ablation for Atrial Fibrillation] rivaroxaban; CIHR, Bayer, Biotronik). The other authors report no conflicts.

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