• Logo
  • SBMUJournals

Reperfusion Delay and its Main Correlates in Patients with ST-Segment Elevation Myocardial Infarction under Primary PCI

Azadeh Sadrzadeh
135

Views

PDF

Abstract

Background: Various strategies have been proposed to minimize reperfusion delay in patients who are candidate for primary percutaneous coronary intervention (PCI). Reperfusion time may be affected by both intra- and extra-hospital factors. The study attempted to identify factors affecting reperfusion time to reduce mortality and morbidity.
Materials and Methods: In this cross-sectional study, 95 patients with chest pain who were admitted to a hospital emergency in Tehran (capital city of Iran) were admitted and those who were diagnosed with ST-segment elevation myocardial infarction (STEMI) were candidates for primary PCI. Basic information was asked from the patients or companion of them. In addition, the PCI time recorded in the patient file was entered in the checklist.
Results: The mean interval between the onset of symptoms and primary PCI was 218.6±21.69 min. The interval between the first medical contact (FMC) and primary PCI was determined to be 87.122±183.66 minutes. The mean time of door to balloon in the hospital was 42.49±78.53 min. In addition, the mean time interval from symptom onset to FMC was 19.47±11.84 minutes. In 31 cases (32.6%), the emergency service (EMS) contacted. Three factors were identified to be associated with a delay between the onset of symptoms to primary PCI (or delay reperfusion time) including the previous history of myocardial infarction (MI) (p=0.034), the severity of coronary artery disease, based on angiography (p=0.043) and the type of vehicle used to transfer the patient to the hospital (p=0.007).
Conclusion: The reperfusion delay seems to be higher in our treatment center than in other centers. Three preceding factors of MI, the severity of coronary artery disease and the transmission of patients via EMS are considered factors associated with the reduction of reperfusion delay.


Keywords

Systolic blood pressure, Pulmonary emboli, CT index

References

Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361:13-20.

Widimský P, Groch L, Zelízko M, Aschermann M, Bednár F, Suryapranata H. Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE study. Eur Heart J. 2000;21:823-31.

Andersen HR, Nielsen TT, Rasmussen K, Thuesen L, Kelbaek H, Thayssen P, et al. A comparison of coronary angioplasty with fibrinolytic therapy in acute myocardial infarction. N Engl J Med. 2003;349:733-42.

Widimský P, Budesínský T, Vorác D, Groch L, Zelízko M, Aschermann M, et al. Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial--PRAGUE-2. Eur Heart J. 2003;24:94-104.

Grines CL, Westerhausen DR, Grines LL, Hanlon JT, Logemann TL, Niemela M, et al. A randomized trial of transfer for primary angioplasty versus on-site thrombolysis in patients with high-risk myocardial infarction: the Air Primary Angioplasty in Myocardial Infarction study. J Am Coll Cardiol. 2002;39:1713-9.

Dalby M, Bouzamondo A, Lechat P, Montalescot G. Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction: a meta-analysis. Circulation. 2003;108:1809-14.

Cannon CP, Gibson CM, Lambrew CT, Shoultz DA, Levy D, French WJ, et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA. 2000;283:2941-7.

McNamara RL, Wang Y, Herrin J, Curtis JP, Bradley EH, Magid DJ, et al. Effect of door-to-balloon time on mortality in patients with ST-segment elevation myocardial infarction. J Am Coll Cardiol. 2006;47:2180-6.

De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004;109:1223-5.

Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk V, et al. Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J. 2008;29:2909-45.

Kushner FG, Hand M, Smith SC, King SB, Anderson JL, Antman EM, et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2009;54:2205-41.

Nallamothu BK, Bates ER, Herrin J, Wang Y, Bradley EH, Krumholz HM. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation. 2005;111:761-7.

Chakrabarti A, Krumholz HM, Wang Y, Rumsfeld JS, Nallamothu BK. Time-to-reperfusion in patients undergoing interhospital transfer for primary percutaneous coronary intervention in the U.S: an analysis of 2005 and 2006 data from the National Cardiovascular Data Registry. J Am Coll Cardiol. 2008;51:2442-3.

Nallamothu BK, Bates ER. Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? Am J Cardiol. 2003;92:824-6.

Betriu A, Masotti M. Comparison of mortality rates in acute myocardial infarction treated by percutaneous coronary intervention versus fibrinolysis. Am J Cardiol. 2005;95:100-1.

Bradley EH, Roumanis SA, Radford MJ, Webster TR, McNamara RL, Mattera JA, Barton BA, Berg DN, Portnay EL, Moscovitz H, et al. Achieving door-to-balloon times that meet quality guidelines: how do successful hospitals do it? J Am Coll Cardiol. 2005;46:1236-41.

Bradley EH, Curry LA, Webster TR, Mattera JA, Roumanis SA, Radford MJ, McNamara RL, Barton BA, Berg DN, Krumholz HM. Achieving rapid door-to-balloon times: how top hospitals improve complex clinical systems. Circulation. 2006;113:1079-85.

Bradley EH, Herrin J, Wang Y, Barton BA, Webster TR, Mattera JA, et al. Strategies for reducing the door-to-balloon time in acute myocardial infarction. N Engl J Med. 2006;355:2308-20.

Krumholz HM, Bradley EH, Nallamothu BK, Ting HH, Batchelor WB, Kline-Rogers E, et al. A campaign to improve the timeliness of primary percutaneous coronary intervention: Door-to-Balloon: An Alliance for Quality. JACC Cardiovasc Interv. 2008;1:97-104.

Knot J, Widimsky P, Wijns W, Stenestrand U, Kristensen SD, Van’ T Hof A, et al. How to set up an effective national primary angioplasty network: lessons learned from five European countries. EuroIntervention. 2009;5:299, 301-9.

Blankenship JC, Skelding KA, Scott TD, Berger PB, Parise H, Brodie BR, et al. Predictors of reperfusion delay in patients with acute myocardial infarction undergoing primary percutaneous coronary intervention from the HORIZONS-AMI trial. Am J Cardiol. 2010;106(11):1527-33.

Rodríguez-Leor O, Fernández-Nofrerías E, Mauri F, Salvatella N, Carrillo X, Curós A, et al. Analysis of reperfusion delay in patients with acute myocardialinfarction treated with primary angioplasty based on first medical contactand time of presentation. Rev Esp Cardiol. 2011;64(6):476-83.

Shavelle DM, Chen AY, Matthews RV, Roe MT, de Lemos JA, Jollis J, et al. Predictors of reperfusion delay in patients with ST elevation myocardialinfarction self-transported to the hospital (from the American Heart)Association's Mission: Lifeline Program. Am J Cardiol. 2014;113(5):798-802.




DOI: https://doi.org/10.22037/nbm.v7i2.22831