Author + information
- Sasha Koul,
- Pontus Andell,
- Andreas Martinsson,
- J. Gustav Smith,
- Jesper van der Pals,
- Fredrik Scherstén,
- Tomas Jernberg,
- Bo Lagerqvist and
- David Erlinge
Early reperfusion in the setting of ST-elevation myocardial infarction (STEMI) is of outmost importance. However the magnitude of early versus late reperfusion on mortality in STEMI patients undergoing primary PCI is unclear. Various studies using symptom-to-PCI as an index of delay have yielded very different Results. Usage of first medical contact to PCI (FMC-to-PCI) as a marker of delay has been evaluated only to a limited extent.
Using the national Swedish SCAAR registry, STEMI patients undergoing primary PCI between the years 2003 and 2008 were screened (n= 21178). Out of these 14 969 had verified ECG to PCI times, an estimate of FMC-to-PCI. Patients with an FMC-to-PCI delay >6 hours (n=1179) were excluded, leaving a total of 13 790 patients for analysis.
Kaplan-Meier curves for unadjusted one-year mortality are shown in Figure 1, with a significant association between FMC-to-PCI delay and mortality. Multivariate analyses showed a significant association between mortality and FMC-to-PCI delays exceeding 1 hour, with an adjusted HR for one-year mortality of 1.30 (60–90 minutes), 1.43 (90–120 minutes) and 1.51 (<120 minutes) compared to a delay of <30 minutes. An association between increased FMC-to-PCI delays and worse ejection fraction was observed.
Delays in FMC-to-PCI is strongly associated with increased mortality at delays of >1 hour, possibly through an increase in severe heart failure. A goal of FMC-to-PCI of less than 1 hour might save patient lives.
Oral Contributions West, Room 3004
Sunday, March 10, 2013, 8:30 a.m.-8:45 a.m.
Session Title: ACS: Outcomes
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 913-5
- 2013 American College of Cardiology Foundation