STEMI Due to Stent Thrombosis and Pain to Door Time: A Beneficial Association

Background: The time from symptom onset to hospital admission (PTD) influences the outcome of patients with STEMI treated with primary PCI. The relationship between patients` clinical and angiographic characteristics and the PTD time is unclear.

Aim: To investigate the relationship between baseline clinical and angiographic characteristics and PTD time of STEMI patients treated by primary PCI (PPCI)

Methods and Results: We analyzed multiple demographic, clinical and angiographic parameters among 1672 consecutive STEMI patients who were admitted to our institution and underwent PPCI . Patients were divided into those who had PTD times of less or more than 2 hours. 53% of patients had a PTD time of less than two hours. They were younger (58±12 vs. 61±13 years, p<0.001), more often male, ( 55% vs 45%, p<0.002) and current or past smokers (56% vs.48%,p=0.002). Diabetes was associated with later presentation (54% vs. 43%, p<0.001). Patients whose STEMI was caused by thrombosis of a previously implanted stent ( 4.1% of our cohort) were more frequent among early presenters ( 67% vs. 53%, p=0.02) and also had a shorter door to reperfusion time ( 78± 56 min vs 85 ± 61 min, p<0.05) Culprit vessel, lesion length and stent diameter did not vary significantly between early and late presenters. In a multivariate analysis, age (OR=1.02 [1.02-1.03] and stent thrombosis as the cause of the current STEMI (OR=1.47 [1.13-1.68] were independently associated with short PTD time.

Conclusion: When STEMI is caused by thrombosis of a previously implanted stent time to hospital admission and time to reperfusion are shorter. Increased awareness by patients and health care providers to the possibility of a repeat acute coronary syndrome rather shortly after a previous event might contribute to this phenomenon but the causes should be further investigated