Effect of Ischemia Duration and Door-to-Balloon Time on Myocardial Perfusion in ST-Segment Elevation Myocardial Infarction: An Analysis From HORIZONS-AMI Trial (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) |
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| Affiliation: | 1. Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota;2. St. George’s, University of London, London, United Kingdom;3. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York;4. Clinical Trials Center, Cardiovascular Research Foundation, New York, New York;6. LeBauer Cardiovascular Research Foundation/Cone Health, Greensboro, North Carolina;5. New York Methodist Hospital, Brooklyn, New York;7. Yale Cardiovascular Research Program, Yale University Medical Center, New Haven, Connecticut;11. Department of Cardiology and Pneumology, Helios Amper-Klinikum, Dachau, Germany;12. Cardiology Division, Rabin Medical Center, Petah-Tikva, Israel;8. Ospedale Papa Giovanni XXIII, Bergamo, Italy;10. Department of Interventional Cardiology, Jagiellonian University, Krakow, Poland |
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| Abstract: | ObjectivesThis study sought to investigate the effect of treatment delay on microvascular reperfusion in ST-segment elevation myocardial infarction (STEMI) patients from the large, multicenter, prospective HORIZONS-AMI (Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction) trial.BackgroundDespite restoration of epicardial blood flow during primary percutaneous coronary intervention (PCI), one-third of patients do not obtain myocardial perfusion due to impairment in the microvascular circulation.MethodsWe examined the effect of symptom onset-to-balloon time (SBT) and door-to-balloon time (DBT) on myocardial reperfusion during primary PCI in STEMI, utilizing resolution of ST-segment elevation (STR) and the myocardial blush grade (MBG). The primary analysis was the relationships between SBT ≤2, >2 to 4, and >4 h and DBT ≤1, >1 to 1.5, >1.5 to 2, and >2 h with MBG and STR. Clinical risk was assessed using a modified version of the Thrombolysis In Myocardial Infarction risk score for STEMI.ResultsIn 2,056 patients, absent microvascular perfusion (MBG 0/1) and STR (STR <30%) after primary PCI was significantly more common in patients with longer SBT, in patients with both low and high clinical risk profiles. By multivariable analysis, SBT (p < 0.0001), anterior infarction (p < 0.0001), reference vessel diameter (p = 0.005), lesion minimum lumen diameter (p < 0.0001), hyperlipidemia (p = 0.03), and current smoking (p = 0.001) were independent predictors of MBG 0/1, whereas SBT (p = 0.007), anterior infarction (p < 0.0001), and history of renal insufficiency (p = 0.0002) were independent predictors of absent STR. DBT (p < 0.0001) was an independent predictor of MBG 0/1. MBG 0/1 and STR<30% identified patients with increased 3-year mortality.ConclusionsThe present study suggests that delay in mechanical reperfusion therapy during STEMI is associated with greater injury to the microcirculation. |
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| Keywords: | ischemia duration myocardial infarction PCI perfusion STEMI DBT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" door-to-balloon time ECG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" electrocardiogram MBG" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" myocardial blush grade PCI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" percutaneous coronary intervention SBT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" symptom onset-to-balloon time STEMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" ST-segment elevation myocardial infarction STR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" ST-segment resolution TIMI" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" Thrombolysis In Myocardial Infarction |
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