Björn Redfors1,2,3, Reza Mohebi1,4, Gennaro Giustino4, Shmuel Chen1,2, Harry P Selker5, Holger Thiele6, Manesh R Patel7, James E Udelson8, E Magnus Ohman7, Ingo Eitel9, Christopher B Granger7, Akiko Maehara1,2, Ziad A Ali1,2,10, Ori Ben-Yehuda1,2, Gregg W Stone1,4. 1. Clinical Trials Center, Cardiovascular Research Foundation, New York, NY (B.R., R.M., S.C., A.M., Z.A.A., O.B.-Y., G.W.S.). 2. Department of Cardiology, NewYork-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY (B.R., S.C., A.M., Z.A.A., O.B.-Y.). 3. Department of Cardiology, Sahlgrenska University Hospital, Gothenburg, Sweden (B.R.). 4. The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY (R.M., G.G., G.W.S.). 5. Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA (H.P.S.). 6. Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute, Germany (H.T.). 7. Duke University Medical Center, Durham, NC (M.R.P., E.M.O., C.B.G.). 8. Division of Cardiology, Tufts Medical Center, Boston, MA (J.E.U.). 9. University Heart Center Lübeck, and the German Center for Cardiovascular Research, Lübeck, Germany (I.E.). 10. St. Francis Hospital, Roslyn, NY (Z.A.A.).
Abstract
BACKGROUND: Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment-elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. METHODS: Individual patient data for 3115 ST-segment-elevation myocardial infarction patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99 m sestamibi single-photon emission computerized tomography (3 studies) or cardiac magnetic resonance imaging (7 studies). MVO was assessed by cardiac magnetic resonance. Patients were stratified by short (≤2 hours), intermediate (2-4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45-90 minutes), or long (>90 minutes) DBTs. RESULTS: Median [interquartile range] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [interquartile range] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference, 2.0% [95% CI, 0.4-3.5] for intermediate versus short SBT and 4.4% [95% CI, 2.7-6.1] for long versus short SBT) but not according to DBT category (adjusted difference, 0.4% [95% CI, -1.2 to 1.9] for intermediate versus short DBT and -0.1% [95% CI, -1.0 to 3.0] for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference, 0.9% [95% CI, 0.3-1.4]) but was not different between patients with intermediate versus short SBT (adjusted difference, 0.1 [95% CI, -0.4 to 0.6]). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. CONCLUSIONS: Among 3115 patients with ST-segment-elevation myocardial infarction undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.
BACKGROUND: Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment-elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. METHODS: Individual patient data for 3115 ST-segment-elevation myocardial infarctionpatients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99 m sestamibi single-photon emission computerized tomography (3 studies) or cardiac magnetic resonance imaging (7 studies). MVO was assessed by cardiac magnetic resonance. Patients were stratified by short (≤2 hours), intermediate (2-4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45-90 minutes), or long (>90 minutes) DBTs. RESULTS: Median [interquartile range] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [interquartile range] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference, 2.0% [95% CI, 0.4-3.5] for intermediate versus short SBT and 4.4% [95% CI, 2.7-6.1] for long versus short SBT) but not according to DBT category (adjusted difference, 0.4% [95% CI, -1.2 to 1.9] for intermediate versus short DBT and -0.1% [95% CI, -1.0 to 3.0] for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference, 0.9% [95% CI, 0.3-1.4]) but was not different between patients with intermediate versus short SBT (adjusted difference, 0.1 [95% CI, -0.4 to 0.6]). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. CONCLUSIONS: Among 3115 patients with ST-segment-elevation myocardial infarction undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.
Authors: Robin Hofmann; Tamrat Befekadu Abebe; Johan Herlitz; Stefan K James; David Erlinge; Joakim Alfredsson; Tomas Jernberg; Thomas Kellerth; Annica Ravn-Fischer; Bertil Lindahl; Sophie Langenskiöld Journal: Front Public Health Date: 2022-01-12