Author + information
- Wamiq Y. Banday,
- M. Fuad Jan,
- Tadele Mengesha,
- Robyn L. Shearer,
- Tanvir Bajwa and
- Suhail Allaqaband
Background: A door-to-balloon time (D2BT) <90 min is a class I indication in patients with ST-elevation myocardial infarction (STEMI). Data are convincing that lowering D2BT is associated with reduced in-hospital mortality in STEMI patients. Whether shorter D2BT improves left ventricular ejection fraction (LVEF) post anterior wall STEMI is unknown. We examined the association between reduced D2BT on LVEF recovery in patients with anterior wall STEMI.
Methods: 392 consecutive anterior wall STEMI patients were treated with primary percutaneous coronary intervention (PPCI) at our tertiary care center from 2004 to 2012. LVEF was measured primarily by transthoracic echocardiography after PPCI before discharge and at 3–24 month follow-up.
Results: Our cohort was predominantly male (70.4%), with mean age of 62.02 years. All patients had anterior wall STEMI. 169 patients (43.1%) had LVEF ≤40% on discharge. LVEF of 76 patients (45%) remained ≤40% (unrecovered) and LVEF of 93 patients (55%) was >40% (recovered) at 3–24 month follow-up. Discharge average LVEF of unrecovered and recovered patients was 29.2% (±6.1) and 35.4% (±4.9), p<0.001, respectively. Average discharge LVEF of unrecovered and recovered patients with D2BT <60 min, 27.3±7.7% and 34.7±4.3% p<0.001, with D2BT 60–90 min, 26.3±4.1% and 35.0±4.5% p<0.001 and D2BT >90 min, 28.1±5.3% and 33.2±4.1% p=0.01, respectively. There is positive association between discharge and follow-up LVEF with a Pearson correlation coefficient of 0.504, p<0.0001.
Conclusions: Our observation suggests that recovery of LVEF at 3–24 months is directly associated with post-PCI and discharge LVEF. It is further observed that LVEF recovery is dismal at 3–24 months in patients with LVEF ≤25% at discharge. This relation of unrecovered LVEF at 3–24 months is consistent across the spectrum of D2BT. Other factors that will improve LVEF irrespective of D2BT need to be elucidated in larger studies.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Considerations in Antiplatelet Therapy and in ACS
Abstract Category: 15. Interventional Cardiology: ACS/AMI/Hemodynamics and Pharmacology
Presentation Number: 1113-148
- 2017 American College of Cardiology Foundation