Strongest Predictors of STEMI Adverse Outcomes in Cardiogenic Shock

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A linear relationship between mortality and treatment delay was found for ST-segment elevation myocardial infarction.
A linear relationship between mortality and treatment delay was found for ST-segment elevation myocardial infarction.

A >90-minute delay in initiating reperfusion therapy from first medical contact is associated high mortality in patients with ST-segment elevation myocardial infarction (STEMI), according to a study published in the European Heart Journal.

In this study, investigators analyzed 12,675 patients presenting with STEMI who experienced treatment delays of <360 minutes (ClinicalTrials.gov Identifier: NCT00794001). Patients with pre-hospital resuscitation for out of hospital cardiac arrest (OHCA, 9.5%), cardiogenic shock (CS, 5.5%), and fibrinolysis (1.1%) were included.

Mortality rates were higher in patients with OHCA and CS compared with patients in stable condition who were treated within a 60- to 180-minute time frame from first medical contact (45% vs 3%, respectively; P <.0001).

In addition, higher mortality rates were observed in patients with a contact to balloon delay of >90 minutes vs ≤90 minutes in high-risk patients with STEMI (12.2% vs 3.9%, respectively; P <.0001).

A significant survival advantage was associated with treatment ≤90 minutes after first medical contact in patients with CS (odds ratio [OR] 0.49; 95% CI, 0.36-0.66; P <.0001). Similar findings were observed in patients with OHCA (OR 0.56; 95% CI, 0.38-0.82; P =.0031).

The investigators noted that patient data were obtained from a sophisticated, well-developed primary percutaneous coronary intervention (PCI) program, so the findings from this study may not be applicable to patients presenting in other care settings. Also, the study could have been enhanced by evaluating longer-term outcomes in patients with timely vs delayed reperfusion.

“Our data suggest that efforts to shorten the time to PCI therapy should be applied to all STEMI patients, and that particularly patients with hemodynamic instability may benefit most from future improvements in STEMI treatment protocols,” the investigators stated.

Reference

Scholz KH, Maier SKG, Maier LS, et al. Impact of treatment delay on mortality in ST-segment elevation myocardial infarction (STEMI) patients presenting with and without haemodynamic instability: results from the German prospective, multicentre FITT-STEMI trial [published online February 14, 2018]. Eur Heart J. doi:10.1093/eurheartj/ehy004

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