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Time Delay, Infarct Size and Microvascular Obstruction After Primary PCI for ST-Segment Elevation Myocardial Infarction.

Redfors, Björn (författare)
Gothenburg University,Göteborgs universitet,Institutionen för medicin, avdelningen för molekylär och klinisk medicin,Institute of Medicine, Department of Molecular and Clinical Medicine
Mohebi, Reza (författare)
Giustino, Gennaro (författare)
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Chen, Shmuel (författare)
Selker, Harry P (författare)
Thiele, Holger (författare)
Patel, Manesh R (författare)
Udelson, James E (författare)
Ohman, E Magnus (författare)
Eitel, Ingo (författare)
Granger, Christopher B (författare)
Maehara, Akiko (författare)
Ali, Ziad A (författare)
Ben-Yehuda, Ori (författare)
Stone, Gregg W (författare)
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2021
2021
Engelska.
Ingår i: Circulation. Cardiovascular interventions. - 1941-7632.
  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • Background: Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. Methods: Individual patient data for 3115 STEMI patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99m sestamibi single-photon emission computerized tomography (SPECT, 3 studies) or cardiac magnetic resonance imaging (CMR, 7 studies). MVO was assessed by CMR. Patients were stratified by short (≤2 hours), intermediate (2-4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45-90 min), or long (>90 minutes) DBTs. Results: Median [IQR] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [IQR] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference 2.0%, 95% confidence interval [CI] 0.4-3.5 for intermediate versus short SBT and 4.4%, 95%CI 2.7-6.1 for long versus short SBT) but not according to DBT category category (adjusted difference 0.4%, 95% CI -1.2 to 1.9 for intermediate versus short DBT and -0.1%, 95% CI -1.0 to 3.0 for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference 0.9%; 95% CI 0.3-1.4) but was not different between patients with intermediate versus short SBT (adjusted difference 0.1; 95% CI -0.4 to 0.6). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. Conclusions: Among 3115 patients with STEMI undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

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