Time-to-treatment and infarct size in STEMI patients undergoing primary angioplasty

Luca, Giuseppe De; Parodi, Guido; Sciagrà, Roberto; Venditti, F.; Bellandi, Benedetta; Vergara, Ruben; Migliorini, Angela; Valenti, Renato; Antoniucci, David

doi:10.1016/j.ijcard.2012.04.078

Cited by 19 publications

(12 citation statements)

References 53 publications

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“…Studies across multiple healthcare systems have shown that delays in emergency service mobilization and hospital treatment occur more frequently after regular working hours, the so-called ‘after-hours’ effect [ 28 , 29 ]. Longer time to treatment has been shown to be linearly associated with infarct size in STEMI [ 30 ]. Higher rates of angioplasty failure and in-hospital mortality are also observed when patients with STEMI are managed ‘after-hours’ as compared with regular working hours [ 31 ].…”

Section: Discussionmentioning

confidence: 99%

Circadian Dependence of Infarct Size and Acute Heart Failure in ST Elevation Myocardial Infarction

et al. 2015

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ObjectivesThere are conflicting data on the relationship between the time of symptom onset during the 24-hour cycle (circadian dependence) and infarct size in ST-elevation myocardial infarction (STEMI). Moreover, the impact of this circadian pattern of infarct size on clinical outcomes is unknown. We sought to study the circadian dependence of infarct size and its impact on clinical outcomes in STEMI.MethodsWe studied 6,710 consecutive patients hospitalized for STEMI from 2006 to 2009 in a tropical climate with non-varying day-night cycles. We categorized the time of symptom onset into four 6-hour intervals: midnight–6:00 A.M., 6:00 A.M.–noon, noon–6:00 P.M. and 6:00 P.M.–midnight. We used peak creatine kinase as a surrogate marker of infarct size.ResultsMidnight–6:00 A.M patients had the highest prevalence of diabetes mellitus (P = 0.03), more commonly presented with anterior MI (P = 0.03) and received percutaneous coronary intervention less frequently, as compared with other time intervals (P = 0.03). Adjusted mean peak creatine kinase was highest among midnight–6:00 A.M. patients and lowest among 6:00 A.M.–noon patients (2,590.8±2,839.1 IU/L and 2,336.3±2,386.6 IU/L, respectively, P = 0.04). Midnight–6:00 A.M patients were at greatest risk of acute heart failure (P<0.001), 30-day mortality (P = 0.03) and 1-year mortality (P = 0.03), while the converse was observed in 6:00 A.M.–noon patients. After adjusting for diabetes, infarct location and performance of percutaneous coronary intervention, circadian variations in acute heart failure incidence remained strongly significant (P = 0.001).ConclusionWe observed a circadian peak and nadir in infarct size during STEMI onset from midnight–6:00A.M and 6:00A.M.–noon respectively. The peak and nadir incidence of acute heart failure paralleled this circadian pattern. Differences in diabetes prevalence, infarct location and mechanical reperfusion may account partly for the observed circadian pattern of infarct size and acute heart failure.

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Section: Discussionmentioning

confidence: 99%

Circadian Dependence of Infarct Size and Acute Heart Failure in ST Elevation Myocardial Infarction

et al. 2015

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“…Our initial population included 894 patients with STEMI treated by primary angioplasty scheduled to undergo evaluation of the infarct size at 30 days after the intervention [21]. A total of 64 patients [16 women (8.7%) and 48 men (7.4%)] were excluded because of death (n ¼ 16), reinfarction (n ¼ 7), or target vessel revascularization (n ¼ 11) within 30 days from revascularization, or refusal to undergo scintigraphy (n ¼ 30).…”

Section: Methodsmentioning

confidence: 99%

“…As previously described [21], gated single-photon emission computed tomography (SPECT) acquisition began 60 min after technetium-99m-sestamibi injection (740 MBq), using a double-head gamma-camera equipped with high-resolution collimators, 1808 rotation arc, 32 projections, 60 s/ projection, 8 frames/heart cycle, and 64 Â 64 matrices. The studies were reconstructed using filtered back-projection without attenuation or scatter correction and realigned along the heart axis.…”

Section: Infarct Size Assessmentmentioning

confidence: 99%

Impact of hypertension on infarct size in ST elevation myocardial infarction patients undergoing primary angioplasty

Luca

Parodi

Sciagrà

et al. 2013

Journal of Hypertension

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Background: Hypertension is a well known risk factor for atherosclerosis. However, data on the impact of hypertension in patients with ST-segment elevation myocardial infarction (STEMI) are inconsistent, and mainly related to studies performed in the thrombolytic era, with very few data on patients undergoing primary angioplasty. The aim of the current study was to evaluate the impact of hypertension on scintigraphic infarct size in STEMI patients undergoing primary percutaneous coronary intervention (PCI). Method: Our population is represented by 830 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. Results: Hypertension was associated with more advanced age (P < 0.001), a larger prevalence of diabetes (P ¼ 0.001), female sex (P < 0.001), but lower prevalence of smoking (P < 0.001) and anterior infarction (P ¼ 0.042). No difference was observed in ischemia time, cardiogenic shock at presentation, in preprocedural thrombolysis in myocardial infarction (TIMI) flow, and collateral circulation. Hypertension did not affect the rate of postprocedural TIMI 3 flow. Hypertension did not affect infarct size [12.5% (4.1-23.8%) vs. 12.8% (4.3-24.7%), P ¼ 0.38]. Similar results were observed in subanalyses in major high-risk subgroups. No impact of hypertension on infarct size was confirmed when the analysis was conducted according to the percentage of patients with infarct size above the median [adjusted odds ratio (95% CI) ¼ 0.97 (0.72-1.33),Conclusion: This study shows that among STEMI patients, undergoing primary PCI hypertension does not affect scintigraphic infarct size.

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“…Multivessel disease was defined as a visually assessed >70% diameter stenosis of at least one major epicardial artery beyond the infarct related artery. Successful primary percutaneous coronary intervention was defined as Thrombolysis In Myocardial Infarction (TIMI) grade 3 coronary flow in the treated vessel with a residual stenosis <20% [17]. Angiographic collaterals were evaluated according to Rentrop classification [18].…”

Section: Coronary Angiography and Mechanical Revascularizationmentioning

confidence: 99%

Impact of multivessel disease on infarct size among STEMI patients undergoing primary angioplasty

Luca¹,

Parodi²,

Sciagrà³

et al. 2014

Atherosclerosis

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a b s t r a c tBackground: Although primary angioplasty achieves Thrombolysis In Myocardial Infarction (TIMI) 3 flow in most patients with ST-elevation myocardial infarction, epicardial recanalization does not guarantee optimal perfusion in a large proportion of patients. Multivessel disease has been demonstrated to be associated with impaired survival, however its impact on infarct size has not been largely investigated, that therefore is the aim of the current study.

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Time-to-treatment and infarct size in STEMI patients undergoing primary angioplasty

Cited by 19 publications

References 53 publications

Circadian Dependence of Infarct Size and Acute Heart Failure in ST Elevation Myocardial Infarction

Circadian Dependence of Infarct Size and Acute Heart Failure in ST Elevation Myocardial Infarction

Impact of hypertension on infarct size in ST elevation myocardial infarction patients undergoing primary angioplasty

Impact of multivessel disease on infarct size among STEMI patients undergoing primary angioplasty

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