Patient delay and benefit of timely reperfusion in ST-segment elevation myocardial infarction
Tim Friede,
Thomas Meyer,
Karl Heinrich Scholz,
Björn Lengenfelder,
Christian Vahlhaus,
Jörn Tongers,
Steffen Schnupp,
Rainer Burckhard,
Nicolas von Beckerath,
Hans-Martin Grusnick,
Andreas Jeron,
Klaus Dieter Winter,
Sebastian K G Maier,
Michael Danner,
Jürgen vom Dahl,
Stefan Neef,
Stefan Stefanow
Affiliations
Tim Friede
Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany, and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
Thomas Meyer
Department of Psychosomatic Medicine and Psychotherapy, University of Göttingen, Göttingen, Germany, and DZHK (German Centre for Cardiovascular Research), partner site Göttingen, Göttingen, Germany
Karl Heinrich Scholz
Department of Cardiology and Intensive Care, St Bernward Hospital, Hildesheim, Germany
Björn Lengenfelder
Department of Cardiology, University of Würzburg, Würzburg, Germany
Christian Vahlhaus
Department of Cardiology and Angiology, University Hospital Münster, Münster, Germany
Jörn Tongers
Department of Cardiology, Medizinische Hochschule Hannover, Hannover, Germany
Steffen Schnupp
Department of Cardiology, Klinikum Coburg, Coburg, Germany
Rainer Burckhard
Department of Cardiology, Donauisar Klinikum Deggendorf, Deggendorf, Germany
Nicolas von Beckerath
Department of Cardiology, Allgemeines Krankenhaus Viersen, Viersen, Germany
Hans-Martin Grusnick
Department of Cardiology, Sana Kliniken Lübeck, Lübeck, Germany
Andreas Jeron
Department of Cardiology, Rems-Murr-Kliniken, Winnenden, Germany
Klaus Dieter Winter
Department of Cardiology, Hermann-Josef-Hospital, Erkelenz, Germany
Sebastian K G Maier
Department of Cardiology, Klinikum Sankt Elisabeth Straubing, Straubing, Germany
Michael Danner
Department of Cardiology, Städtisches Klinikum, München Neuperlach, Munich, Germany
Jürgen vom Dahl
Department of Cardiology, Kliniken Maria Hilf, Mönchengladbach, Germany
Stefan Neef
Department of Cardiology, University Hospital Regensburg, Regensburg, Germany
Stefan Stefanow
Department of Cardiology, Klinikum Ludwigsburg, Ludwigsburg, Ludwigsburg, Germany
Background In patients with ST-segment elevation myocardial infarction (STEMI), it is unknown how patient delay modulates the beneficial effects of timely reperfusion.Aims To assess the prognostic significance of a contact-to-balloon time of less than 90 min on in-hospital mortality in different categories of symptom-onset-to-first-medical-contact (S2C) times.Methods A total of 20 005 consecutive patients from the Feedback Intervention and Treatment Times in ST-segment Elevation Myocardial Infarction (FITT-STEMI) programme treated with primary percutaneous coronary intervention (PCI) were included.Results There were 1554 deaths (7.8%) with a J-shaped relationship between mortality and S2C time. Mortality was 10.0% in patients presenting within 1 hour, and 4.9%, 6.0% and 7.3% in patient groups with longer S2C intervals of 1–2 hours, 2–6 hours and 6–24 hours, respectively. Patients with a short S2C interval of less than 1 hour (S2C<60 min) had the highest survival benefit from timely reperfusion with PCI within 90 min (OR 0.27, 95% CI 0.23 to 0.31, p<0.0001) as compared with the three groups with longer S2C intervals of 1 hour<S2C≤2 hours (OR 0.44, 95% CI 0.33 to 0.59, p<0.0001), 2 hours<S2C≤6 hours (OR 0.49, 95% CI 0.38 to 0.64, p<0.0001) and 6 hours<S2C≤24 hours (OR 0.42, 95% CI 0.30 to 0.58, p<0.0001).Conclusions Timely reperfusion with a contact-to-balloon time of less than 90 min is most effective in patients presenting with short S2C intervals of less than 1 hour, but has also beneficial effects in patients with S2C intervals of up to 24 hours.Trial registration number NCT00794001.