Total Ischemic Time and Short, Intermediate and Long Term Mortality of Patients with STEMI Treated by PPCI

Objective:
Our objective was to evaluate correlation between mortality and total ischemic time in a large cohort of ST Elevation Myocardial Infarction (STEMI) patients.

Background:
Several previous studies demonstrated positive correlation between door to

balloon time and mortality.

However, several recent studies failed to find improvement in mortality with shortened door to

balloon time. It is possible that further reduction in mortality of STEMI patients in the modern

era of PPCI and adjuvant pharmacotherapy could be achieved only by means of reduction of

total ischemic time.

Methods: We analyzed data of 2254 consecutive patients with STEMI treated by PPCI and enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) registry. We divided our cohort into tertiles based on the total ischemic time: less than 150 minutes (group 1, n=730), between 150 and 265 minutes (group 2, n=758) and above 265 minutes (group 3, n=766). Our primary end points were 30-day ,1-year and 5 years mortality.

Our secondary end point was LVEF less than 40% at discharge.

Results:
There was no difference in 30-day or 1-year mortality between the three study groups.

There was significantly lower 5-year mortality in the shortest ( less than 150 minutes) total ischemic time group.

Conclusions:
Shortening of total ischemic time below 150 minutes is associated with improved long term survival. The quality measure of door to balloon time should be re considered.

Measures should be undertaken to reduce total ischemic time.