TY - JOUR
T1 - Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction
AU - Lonborg, Jacob
AU - Schoos, Mikkel Malby
AU - Kelbæk, Henning
AU - Holmvang, Lene
AU - Steinmetz, Jacob
AU - Vejlstrup, Niels
AU - Jorgensen, Erik
AU - Helqvist, Steffen
AU - Saunamäki, Kari
AU - Botker, Hans Erik
AU - Kim, Won Yong
AU - Terkelsen, Christian Juhl
AU - Clemmensen, Peter
AU - Engstrom, Thomas
PY - 2012/10/1
Y1 - 2012/10/1
N2 - Background: The association between reperfusion delay and myocardial damage has previously been assessed by evaluation of the duration from symptom onset to invasive treatment, but results have been conflicting. System delay defined as the duration from first medical contact to first balloon dilatation is less prone to bias and is also modifiable. The purpose was to evaluate the impact of system delay on myocardial salvage index (MSI) and infarct size in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI). Methods: In patients with ST-elevation myocardial infarction, MSI and final infarct size were assessed using cardiovascular magnetic resonance. Myocardial area at risk was measured within 1 to 7 days, and final infarct size was measured 90 ± 21 days after intervention. Patients were grouped according to system delay (0 to 120, 121 to 180, and >180 minutes). Results: In 219 patients, shorter system delay was associated with a smaller infarct size (8% [interquartile range 4-12%], 10% [6-16%], and 13% [8-17%]; P <.001) and larger MSI (0.77 [interquartile range 0.66-0.86], 0.72 [0.59-0.80], and 0.68 [0.64-0.72]; P =.005) for a system delay of up to 120, 121 to 180, and >180 minutes, respectively. A short system delay as a continuous variable independently predicted a smaller infarct size (r = 0.30, P <.001) and larger MSI (r = -0.25, P <.001) in multivariable linear regression analyses. Finally, shorter system delay (0-120 minutes) was associated with improved function (P =.019) and volumes of left ventricle (P =.022). Conclusions: A shorter system delay resulted in smaller infarct size, larger MSI, and improved LV function in patients treated with primary PCI. Thus, this study confirms that minimizing system delay is crucial for primary PCI-related benefits.
AB - Background: The association between reperfusion delay and myocardial damage has previously been assessed by evaluation of the duration from symptom onset to invasive treatment, but results have been conflicting. System delay defined as the duration from first medical contact to first balloon dilatation is less prone to bias and is also modifiable. The purpose was to evaluate the impact of system delay on myocardial salvage index (MSI) and infarct size in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI). Methods: In patients with ST-elevation myocardial infarction, MSI and final infarct size were assessed using cardiovascular magnetic resonance. Myocardial area at risk was measured within 1 to 7 days, and final infarct size was measured 90 ± 21 days after intervention. Patients were grouped according to system delay (0 to 120, 121 to 180, and >180 minutes). Results: In 219 patients, shorter system delay was associated with a smaller infarct size (8% [interquartile range 4-12%], 10% [6-16%], and 13% [8-17%]; P <.001) and larger MSI (0.77 [interquartile range 0.66-0.86], 0.72 [0.59-0.80], and 0.68 [0.64-0.72]; P =.005) for a system delay of up to 120, 121 to 180, and >180 minutes, respectively. A short system delay as a continuous variable independently predicted a smaller infarct size (r = 0.30, P <.001) and larger MSI (r = -0.25, P <.001) in multivariable linear regression analyses. Finally, shorter system delay (0-120 minutes) was associated with improved function (P =.019) and volumes of left ventricle (P =.022). Conclusions: A shorter system delay resulted in smaller infarct size, larger MSI, and improved LV function in patients treated with primary PCI. Thus, this study confirms that minimizing system delay is crucial for primary PCI-related benefits.
UR - http://www.scopus.com/inward/record.url?scp=84867521142&partnerID=8YFLogxK
U2 - 10.1016/j.ahj.2012.07.021
DO - 10.1016/j.ahj.2012.07.021
M3 - Article
C2 - 23067912
AN - SCOPUS:84867521142
SN - 0002-8703
VL - 164
SP - 538
EP - 546
JO - American Heart Journal
JF - American Heart Journal
IS - 4
ER -