Objective: Our objective was to evaluate correlation between clinical outcomes and LV function 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 three groups based on the total ischemic time: less than 150 minutes (n=730), between 150 and 265 minutes (n=758) and above 265 minutes (n=766). Our primary end points were 30-day MACCE and 30-day and 1-year mortality. Our secondary end point was LVEF less than 40% at discharge.
We performed subgroup analysis of patients with anterior STEMI (n=1102).
Results: There was no difference in 30-day MACCE and 30-day or 1-year mortality between the three study groups of the main cohort and the anterior STEMI subgroup.
There were significantly more patients with LVEF less than 40% in the group with the longest total ischemic time (7.59% , 8.07% and 10% in the first, second and third group, p=0.0008).
Conclusions: Shortening of total ischemic time below 150 minutes is not associated with reduction in 30 day MACE and 30 day and 1 year mortality. However, shortening of total ischemic time below 265 minutes is associated with better LV function at discharge.
