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Impact of diagnostic ECG-to-wire delay in STEMI patients treated with primary PCI : A DANAMI-3 substudy

Nepper-Christensen, Lars ; Lønborg, Jacob ; Høfsten, Dan Eik ; Ahtarovski, Kiril Aleksov ; Kyhl, Kasper ; Göransson, Christoffer ; Køber, Lars ; Helqvist, Steffen ; Pedersen, Frants and Kelbæk, Henning , et al. (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.

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organization
publishing date
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
  • pmid:29278352
  • scopus:85053607652
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
2020-10-20 04:23:20
@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) &gt;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 &gt;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 &gt;120 minutes still had a substantial myocardial salvage ≥0.50. In a multivariable analysis, ECG-to-wire &gt;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 &gt;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},
  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},
}