Impact of Total Ischemic Time on Clinical Outcome in Stemi Patients Undergoing Percutaneous Coronary Intervention
DOI:
https://doi.org/10.61919/jhrr.v4i1.512Keywords:
ST-segment elevation, myocardial infarction, percutaneous coronary intervention, total ischemic time, clinical outcomes, all-cause mortality, re-hospitalization, revascularizationAbstract
Background: ST-segment elevation myocardial infarction (STEMI) represents a critical condition requiring prompt treatment to minimize myocardial damage. Percutaneous coronary intervention (PCI) is the preferred reperfusion strategy, with the total ischemic time (TIT) being a crucial determinant of clinical outcomes. Despite the recognized importance of minimizing door-to-balloon (DTB) time, the impact of TIT on STEMI outcomes necessitates further exploration.
Objective: This study aimed to evaluate the association between TIT and clinical outcomes in STEMI patients undergoing PCI, specifically focusing on all-cause mortality, re-hospitalization, and revascularization rates.
Methods: A descriptive study was conducted at the cardiology ward of Lady Reading Hospital from May 2023 to October 2023. Ninety patients diagnosed with STEMI and undergoing PCI were enrolled. Patients were excluded if they had a history of cardiac surgeries or a DTB time >90 minutes. TIT was categorized into ≤120 minutes (Group A) and >120 minutes (Group B). Clinical outcomes assessed at 6 months post-PCI included all-cause mortality, cardiac mortality, re-hospitalization, and revascularization. Data were analyzed using SPSS version 25, employing Chi-Square tests for categorical variables, with a p-value ≤ 0.05 considered statistically significant.
Results: Among the participants, Group A (TIT ≤ 120 mins) comprised 33 patients, while Group B (TIT > 120 mins) included 57 patients. Increased TIT was associated with higher rates of all-cause mortality (21.1% in Group B vs. 6.1% in Group A, p=0.05), re-hospitalization (22.8% vs. 6.1%, p=0.04), and revascularization (29.8% vs. 12.1%, p=0.05). Cardiac mortality was also higher in Group B (10.5%) compared to Group A (3.0%), though this difference was not statistically significant (p=0.20).
Conclusion: The study highlights the significant impact of TIT on the prognosis of STEMI patients undergoing PCI. Shorter TIT is associated with markedly better clinical outcomes, emphasizing the need for healthcare systems to adopt strategies that reduce both pre-hospital and in-hospital delays.
Downloads
References
Reed GW, Rossi JE, Cannon CP. Acute myocardial infarction. Lancet. 2017;389(10065):197-210.
Vogel B, Claessen BE, Arnold SV, Chan D, Cohen DJ, Giannitsis E, et al. ST-segment elevation myocardial infarction. Nature reviews Disease primers. 2019;5(1):39-42.
Pagliaro BR, Cannata F, Stefanini GG, Bolognese L. Myocardial ischemia and coronary disease in heart failure. Heart Failure Reviews. 2020;25(1):53-65.
Apple FS, Sandoval Y, Jaffe AS, Ordonez-Llanos J. IFCC Task Force on Clinical Applications of Cardiac Bio-Markers. Cardiac Troponin Assays: Guide to Understanding Analytical Characteristics and Their Impact on Clinical Care. Clin Chem. 2017;63(1):73-81.
Goodman SG, Steg PG, Eagle KA, Fox KA, López-Sendón J, Montalescot G, et al. GRACE Investigators. The diagnostic and prognostic impact of the redefinition of acute myocardial infarction: lessons from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2006;151(3):654-60.
Jneid H, Addison D, Bhatt DL, Fonarow GC, Gokak S, Grady KL, et al. 2017 AHA/ACC clinical performance and quality measures for adults with ST-elevation and non–ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Performance Measures. Circulation: Cardiovascular Quality and Outcomes. 2017;10(10):e000032.
Latifi AN, Akram A, Dengle S, Minhas A, Borz-Baba C. Use of guideline-directed medical therapy in patients with ST-elevation myocardial infarction. Cureus. 2020;12(7):22-7.
Addison D, Bhatt DL, Fonarow FG, Gokak FS, Grady KL, Green FL, et al. 2017 AHA/ACC Clinical Performance and Quality Measures for Adults With ST-Elevation and Non–ST-Elevation Myocardial Infarction. Journal Of The American College Of Cardiology. 2017;70(16):42-6.
Ibanez B, James S, Agewall S, Antunes MJ, Bucciarelli-Ducci C, Bueno H, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European heart journal. 2018;39(2):119-77.
Prasad A, Gersh BJ, Mehran R, Brodie BR, Brener SJ, Dizon JM, et al. 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). JACC: Cardiovascular Interventions. 2015;8(15):1966-74.
Khowaja S, Ahmed S, Kumar R, Shah JA, Khan KA, Khan NU, et al. Time to think beyond door to balloon time: significance of total ischemic time in STEMI. The Egyptian Heart Journal. 2021;73(1):1-7.
Yudi MB, Ramchand J, Farouque O, Andrianopoulos N, Chan W, Duffy SJ, et al. Impact of door-to-balloon time on long-term mortality in high-and low-risk patients with ST-elevation myocardial infarction. International journal of cardiology. 2016;224:72-8.
Gibson CM, Pride YB, Frederick PD, Pollack Jr CV, Canto JG, Tiefenbrunn AJ, et al. Trends in reperfusion strategies, door-to-needle and door-to-balloon times, and in-hospital mortality among patients with ST-segment elevation myocardial infarction enrolled in the National Registry of Myocardial Infarction from 1990 to 2006. American heart journal. 2008;156(6):1035-44.
Braunwald E. Unstable angina and non-ST elevation myocardial infarction. Am J Respir Crit Care Med. 2012;185:924–32.
Chung SC, Gedeborg R, Nicholas O, James S, Jeppsson A, Wolfe C, et al. Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK. Lancet. 2014;383:1305–12.
Chapman AR, Shah ASV, Lee KK, Anand A, Francis O, Adamson P, et al. Long-term outcomes in patients with type 2 myocardial infarction and myocardial injury. Circulation. 2018;137:1236–45.
Khowaja S, Ahmed S, Kumar R, et al. Time to think beyond door-to-balloon time: Significance of total ischemic time in STEMI. Egypt Heart J. 2021;73:95.
Chandrasekhar J, Marley P, Allada C, McGill D, O’Connor S, Rahman M, Tan R, Hosseiny AD, Shadbolt B, Farshid A. Symptom-to-balloon time is a strong predictor of adverse events following primary percutaneous coronary intervention: Results from the Australian Capital Territory PCI Registry. Heart Lung Circ. 2017;26(1):41–48.
Kurmi P, Tripathi VD, Tripathi SK. Impact of Total Ischemic Time on Clinical Outcomes in Patients With ST-Elevation Myocardial Infarction: Lost Time Is Never Found Again. Cureus. 2022;14(3):e23143.
Abusharekh M, Kampf J, Dykun I, Souri K, Backmann V, Al-Rashid F, Jánosi RA, Totzeck M, Lawo T, Rassaf T, Mahabadi AA. Acute coronary occlusion with vs. without ST elevation: impact on procedural outcomes and long-term all-cause mortality. European Heart Journal-Quality of Care and Clinical Outcomes. 2024 Jan 8:qcae003.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Tariq Nawaz, Hassan Ali, Sadam Hussain, Wasim Sajjad, Muhammad Amin
This work is licensed under a Creative Commons Attribution 4.0 International License.
