Impact of diagnostic ECG-to-wire delay in STEMI patients treated with primary PCI: A DANAMI-3 substudy

Research output: Contribution to journalArticle

Abstract

Aims: We aimed to evaluate the impact of delay from diagnostic pre-hospital electrocardiogram (ECG) to wiring of the infarct-related vessel (ECG-to-wire) >120 minutes on cardiovascular magnetic resonance (CMR) markers of reperfusion success and clinical outcome in patients with ST-segment elevation myocardial infarction (STEMI). Methods and results: We included 1,492 patients in the analyses of clinical outcome. CMR was performed in 748 patients to evaluate infarct size and myocardial salvage. In total, 304 patients (20%) had ECG-to-wire >120 minutes, which was associated with larger acute infarct size (18% [interquartile range (IQR), 10-28] vs. 15% [8-24]; p=0.022) and smaller myocardial salvage (0.42 [IQR 0.28-0.57] vs. 0.50 [IQR 0.34-0.70]; p=0.002). However, 33% of the patients with ECG-to-wire >120 minutes still had a substantial myocardial salvage ≥0.50. In a multivariable analysis, ECG-to-wire >120 minutes was associated with an increased risk of all-cause mortality and heart failure (hazard ratio 1.61, 95% confidence interval [CI] 1.14-2.26, p=0.007). Conclusions: ECG-to-wire >120 minutes was associated with larger infarct size, smaller myocardial salvage and a poorer clinical outcome in STEMI patients transferred for primary percutaneous coronary intervention. However, myocardial salvage was still substantial in one third of patients treated beyond 120 minutes of delay.

Details

Authors
  • Lars Nepper-Christensen
  • Jacob Lønborg
  • Dan Eik Høfsten
  • Kiril Aleksov Ahtarovski
  • Kasper Kyhl
  • Christoffer Göransson
  • Lars Køber
  • Steffen Helqvist
  • Frants Pedersen
  • Henning Kelbæk
  • Niels Vejlstrup
  • Lene Holmvang
  • Thomas Engstrøm
Organisations
External organisations
  • Copenhagen University Hospital
  • Zealand University Hospital
Research areas and keywords

Subject classification (UKÄ) – MANDATORY

  • Cardiac and Cardiovascular Systems

Keywords

  • Clinical research, MRI, Myocardial infarction, STEMI
Original languageEnglish
Pages (from-to)700-707
Number of pages8
JournalEuroIntervention
Volume14
Issue number6
Publication statusPublished - 2018
Publication categoryResearch
Peer-reviewedYes