Total ischaemic time and 9-year outcomes in STEMI patients treated with pPCI

- Nine-year prognosis in an unselected STEMI patients treated with pPCI is unexpectedly good.
- Total ischaemic time (TIT) is strongly related with long-term mortality in STEMI patients.
- Longer TIT is also an independent predictor of procedural failure.
- Advanced age, diabetes mellitus and history of CAD are independently associated with prolonged TIT.
- The direct field-triage helps reduce TIT.

BackgroundProlonged total ischaemic time (TIT) has been shown to independently predict poor myocardial perfusion in STEMI patients and affect in-hospital mortality. We aim to evaluate the influence of TIT on long-term follow-up (F/U) and identify the factors associated with TIT in patients with STEMI treated with pPCI at a high volume centre.MethodsIn a prospective “all-comer” registry, clinical, angiographic and procedural characteristics, TIT and 9-year mortality were determined in consecutive STEMI patients treated with pPCI. Patients were divided according to TIT into three groups: A) < 3, B) 3-6 and C) > 6 h.ResultsAmong 1064 patients, TIT was known in 1002 patients, 5 patients were lost to F/U. For censored observations F/U was 7.2-8.8 years. There were 350, 461, and 186 patients in groups A, B, and C, respectively. Patients in group A compared to B and C were younger, more often males and smokers, less frequently had history of CAD, and more frequently had occluded infarct related artery. However, final TIMI3 was obtained more frequently. Overall 30-day mortality was 4%, one-year mortality 7% and nine-year mortality 27%. Multivariable logistic regression models indicated that longer TIT was associated with a higher risk of 9-year mortality (A-21%, B-28%, C-37%, p < 0.0005). TIT > 6 h was independently associated with advanced age, diabetes mellitus, history of CAD and higher rate of initial TIMI grade flow 3.ConclusionsTIT is strongly related with mortality in STEMI patients even after nine years of F/U. This finding reinforces the necessity of shortening the TIT in all STEMI patients.