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Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction

Nepper-Christensen, Lars; Lønborg, Jacob; Høfsten, Dan E.; Ahtarovski, Kiril A.; Bang, Lia E.; Helqvist, Steffen; Kyhl, Kasper; Køber, Lars; Kelbæk, Henning and Vejlstrup, Niels, et al. (2018) In Circulation. Cardiovascular Interventions 11(9). p.006842-006842
Abstract

BACKGROUND: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting <12 hours.

METHODS AND RESULTS: We included 865 STEMI patients who underwent cardiac magnetic resonance just after index PCI and 3 months later. Despite equal area at risk (34±12% versus 33±12%; P=0.370), patients... (More)

BACKGROUND: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting <12 hours.

METHODS AND RESULTS: We included 865 STEMI patients who underwent cardiac magnetic resonance just after index PCI and 3 months later. Despite equal area at risk (34±12% versus 33±12%; P=0.370), patients presenting late (n=58) had larger final infarct size (13% [interquartile range, 9-24] versus 11% [interquartile range, 4-19]; P=0.037) and smaller myocardial salvage index (0.58 [interquartile range, 0.39-0.71] versus 0.65 [interquartile range, 0.49-0.84]; P=0.021) compared with patients presenting <12 hours after symptom onset (n=807). However, 65% of late-presenting patients achieved substantial myocardial salvage ≥0.50, and area under the curve for symptom onset to PCI as predictor of a myocardial salvage index ≥0.50 was poor (0.58 [95% CI, 0.53-0.63]; P<0.001). In addition, final infarct size, salvage index and left ventricular function correlated weakly with duration from symptom onset to primary PCI ( R2 values <0.05).

CONCLUSIONS: STEMI patients with signs of ongoing ischemia treated with primary PCI 12 to 72 hours after symptom onset had less myocardial salvage and developed larger infarcts. However, a large proportion achieved substantial myocardial salvage indicating a benefit from primary PCI in late-presenting patients.

CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01435408 and NCT01960933.

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publication status
published
subject
keywords
magnetic resonance imaging, myocardial infarction, percutaneous coronary intervention, reperfusion, ST-segment–elevation myocardial infarction
in
Circulation. Cardiovascular Interventions
volume
11
issue
9
pages
006842 - 006842
publisher
American Heart Association
external identifiers
  • scopus:85055601009
ISSN
1941-7632
DOI
10.1161/CIRCINTERVENTIONS.118.006842
language
English
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yes
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5f31330e-53b6-4a6c-ace1-9fc049b7c2ce
date added to LUP
2018-11-16 13:16:54
date last changed
2019-11-13 05:20:35
@article{5f31330e-53b6-4a6c-ace1-9fc049b7c2ce,
  abstract     = {<p>BACKGROUND: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting &lt;12 hours.</p><p>METHODS AND RESULTS: We included 865 STEMI patients who underwent cardiac magnetic resonance just after index PCI and 3 months later. Despite equal area at risk (34±12% versus 33±12%; P=0.370), patients presenting late (n=58) had larger final infarct size (13% [interquartile range, 9-24] versus 11% [interquartile range, 4-19]; P=0.037) and smaller myocardial salvage index (0.58 [interquartile range, 0.39-0.71] versus 0.65 [interquartile range, 0.49-0.84]; P=0.021) compared with patients presenting &lt;12 hours after symptom onset (n=807). However, 65% of late-presenting patients achieved substantial myocardial salvage ≥0.50, and area under the curve for symptom onset to PCI as predictor of a myocardial salvage index ≥0.50 was poor (0.58 [95% CI, 0.53-0.63]; P&lt;0.001). In addition, final infarct size, salvage index and left ventricular function correlated weakly with duration from symptom onset to primary PCI ( R2 values &lt;0.05).</p><p>CONCLUSIONS: STEMI patients with signs of ongoing ischemia treated with primary PCI 12 to 72 hours after symptom onset had less myocardial salvage and developed larger infarcts. However, a large proportion achieved substantial myocardial salvage indicating a benefit from primary PCI in late-presenting patients.</p><p>CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01435408 and NCT01960933.</p>},
  author       = {Nepper-Christensen, Lars and Lønborg, Jacob and Høfsten, Dan E. and Ahtarovski, Kiril A. and Bang, Lia E. and Helqvist, Steffen and Kyhl, Kasper and Køber, Lars and Kelbæk, Henning and Vejlstrup, Niels and Holmvang, Lene and Engstrøm, Thomas},
  issn         = {1941-7632},
  keyword      = {magnetic resonance imaging,myocardial infarction,percutaneous coronary intervention,reperfusion,ST-segment–elevation myocardial infarction},
  language     = {eng},
  number       = {9},
  pages        = {006842--006842},
  publisher    = {American Heart Association},
  series       = {Circulation. Cardiovascular Interventions},
  title        = {Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction},
  url          = {http://dx.doi.org/10.1161/CIRCINTERVENTIONS.118.006842},
  volume       = {11},
  year         = {2018},
}