Publication details

The relationship between symptom onset-to-needle time and ischemic outcomes in patients with acute myocardial infarction treated with primary PCI Observations from Prague-18 Study

Authors

HROMADKA Milan MOTOVSKA Zuzana HLINOMAZ Ota KALA Petr VARVAROVSKY Ivo DUSEK Jaroslav SVOBODA Michal JARKOVSKÝ Jiří TOUSEK Frantisek JANSKY Pavel SIMEK Stanislav BRANNY Marian MROZEK Jan MIKLÍK Roman ROKYTA Richard WIDIMSKY Petr

Year of publication 2022
Type Article in Periodical
Magazine / Source JOURNAL OF CARDIOLOGY
MU Faculty or unit

Faculty of Medicine

Citation
Web https://www.sciencedirect.com/science/article/pii/S0914508721003385?via%3Dihub
Doi http://dx.doi.org/10.1016/j.jjcc.2021.11.015
Keywords Acute myocardial infarction; Symptoms onset to needle time; Risk stratification; P2Y12 inhibitors; Ischemic endpoints
Description Objectives: Based on previous studies with clopidogrel, the time between acute myocardial infarction (AMI) symptoms onset and primary percutaneous coronary intervention (PCI) was proven as important prognostic factor. Our aim was to assess the relationship between symptoms onset to needle time (SNT) and procedural results and the occurrence of ischemic endpoints in primary angioplasty patients treated with potent P2Y12 inhibitors. Methods: A total of 1,131 out of 1,230 patients randomized to the Prague-18 study (prasugrel vs. ticagrelor in primary PCI) were divided into a high and a low-risk group. The effect of defined SNT on patients' ischemic endpoints and prognosis by their risk status at admission was tested. Results: The median SNT was 3.2 hours. Longer SNTs resulted in a more frequent incidence of TIMI flow <3 post PCI (p=0.015). There were significant differences in the occurrence of the combined ischemic endpoint among the compared SNT groups at 30 days (p=0.032), and 1 year (p=0.011), with the highest incidence in the <<= 1 h SNT group of patients. "Latecomers" (SNT>4 hs) in the high-risk group experienced more reinfarction within 1 year [OR (95% CI) 3.23 (1.09-9.62) p=0.035]; no difference was found in the low-risk group. Conclusions: In the era of intense antithrombotic medication, stratification of MI patients undergoing primary angioplasty, based on initial ischemic risk assessment affected prognosis more than symptom onset to needle time. Longer time delay was significantly related to increased incidence of ischemic events and all-cause mortality only in patients with high ischemic risk. (C) 2021 Japanese College of Cardiology. Published by Elsevier Ltd. All rights reserved.

You are running an old browser version. We recommend updating your browser to its latest version.

More info