Impact of diagnostic ECG-to-wire delay in STEMI patients treated with primary PCI : A DANAMI-3 substudy
(2018) In EuroIntervention 14(6). p.700-707- Abstract
Aims: We aimed to evaluate the impact of delay from diagnostic pre-hospital electrocardiogram (ECG) to wiring of the infarct-related vessel (ECG-to-wire) >120 minutes on cardiovascular magnetic resonance (CMR) markers of reperfusion success and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Methods and results: We included 1,492 patients in the analyses of clinical outcome. CMR was performed in 748 patients to evaluate infarct size and myocardial salvage. In total, 304 patients (20%) had ECG-to-wire >120 minutes, which was associated with larger acute infarct size (18% [interquartile range (IQR), 10-28] vs. 15% [8-24]; p=0.022) and smaller myocardial salvage (0.42 [IQR 0.28-0.57] vs. 0.50... (More)
Aims: We aimed to evaluate the impact of delay from diagnostic pre-hospital electrocardiogram (ECG) to wiring of the infarct-related vessel (ECG-to-wire) >120 minutes on cardiovascular magnetic resonance (CMR) markers of reperfusion success and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Methods and results: We included 1,492 patients in the analyses of clinical outcome. CMR was performed in 748 patients to evaluate infarct size and myocardial salvage. In total, 304 patients (20%) had ECG-to-wire >120 minutes, which was associated with larger acute infarct size (18% [interquartile range (IQR), 10-28] vs. 15% [8-24]; p=0.022) and smaller myocardial salvage (0.42 [IQR 0.28-0.57] vs. 0.50 [IQR 0.34-0.70]; p=0.002). However, 33% of the patients with ECG-to-wire >120 minutes still had a substantial myocardial salvage ≥0.50. In a multivariable analysis, ECG-to-wire >120 minutes was associated with an increased risk of all-cause mortality and heart failure (hazard ratio 1.61, 95% confidence interval [CI] 1.14-2.26, p=0.007). Conclusions: ECG-to-wire >120 minutes was associated with larger infarct size, smaller myocardial salvage and a poorer clinical outcome in STEMI patients transferred for primary percutaneous coronary intervention. However, myocardial salvage was still substantial in one third of patients treated beyond 120 minutes of delay.
(Less)
- author
- organization
- publishing date
- 2018
- type
- Contribution to journal
- publication status
- published
- subject
- keywords
- Clinical research, MRI, Myocardial infarction, STEMI
- in
- EuroIntervention
- volume
- 14
- issue
- 6
- pages
- 8 pages
- publisher
- Société Europa Edition
- external identifiers
-
- scopus:85053607652
- pmid:29278352
- ISSN
- 1774-024X
- DOI
- 10.4244/EIJ-D-17-00857
- language
- English
- LU publication?
- yes
- id
- b07b9a46-dbd9-4b79-be0d-f031032c535d
- date added to LUP
- 2018-10-17 15:33:36
- date last changed
- 2024-09-18 04:34:45
@article{b07b9a46-dbd9-4b79-be0d-f031032c535d, abstract = {{<p>Aims: We aimed to evaluate the impact of delay from diagnostic pre-hospital electrocardiogram (ECG) to wiring of the infarct-related vessel (ECG-to-wire) >120 minutes on cardiovascular magnetic resonance (CMR) markers of reperfusion success and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Methods and results: We included 1,492 patients in the analyses of clinical outcome. CMR was performed in 748 patients to evaluate infarct size and myocardial salvage. In total, 304 patients (20%) had ECG-to-wire >120 minutes, which was associated with larger acute infarct size (18% [interquartile range (IQR), 10-28] vs. 15% [8-24]; p=0.022) and smaller myocardial salvage (0.42 [IQR 0.28-0.57] vs. 0.50 [IQR 0.34-0.70]; p=0.002). However, 33% of the patients with ECG-to-wire >120 minutes still had a substantial myocardial salvage ≥0.50. In a multivariable analysis, ECG-to-wire >120 minutes was associated with an increased risk of all-cause mortality and heart failure (hazard ratio 1.61, 95% confidence interval [CI] 1.14-2.26, p=0.007). Conclusions: ECG-to-wire >120 minutes was associated with larger infarct size, smaller myocardial salvage and a poorer clinical outcome in STEMI patients transferred for primary percutaneous coronary intervention. However, myocardial salvage was still substantial in one third of patients treated beyond 120 minutes of delay.</p>}}, author = {{Nepper-Christensen, Lars and Lønborg, Jacob and Høfsten, Dan Eik and Ahtarovski, Kiril Aleksov and Kyhl, Kasper and Göransson, Christoffer and Køber, Lars and Helqvist, Steffen and Pedersen, Frants and Kelbæk, Henning and Vejlstrup, Niels and Holmvang, Lene and Engstrøm, Thomas}}, issn = {{1774-024X}}, keywords = {{Clinical research; MRI; Myocardial infarction; STEMI}}, language = {{eng}}, number = {{6}}, pages = {{700--707}}, publisher = {{Société Europa Edition}}, series = {{EuroIntervention}}, title = {{Impact of diagnostic ECG-to-wire delay in STEMI patients treated with primary PCI : A DANAMI-3 substudy}}, url = {{http://dx.doi.org/10.4244/EIJ-D-17-00857}}, doi = {{10.4244/EIJ-D-17-00857}}, volume = {{14}}, year = {{2018}}, }