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- Copyright © 2022 Jeong Hun Seo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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Abstract
Hindawi Journal of Interventional Cardiology Volume 2022, Article ID 2447707, 9 pages https://doi.org/10.1155/2022/2447707 Research Article Impact of Total Ischemic Time on the Recovery of Regional Wall Motion Abnormality after STEMI in the Modern Reperfusion Era 1 2 1 1 1 Jeong Hun Seo, Kang Hee Kim, Kwang-Jin Chun, Bong-Ki Lee, Byung-Ryul Cho, and Dong Ryeol Ryu Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, Chuncheon-Si, Gangwon-Do, Republic of Korea Department of Internal Medicine, Kangwon National University Hospital, Chuncheon-Si, Gangwon-Do, Republic of Korea Correspondence should be addressed to Dong Ryeol Ryu; rdr0203@gmail.com Received 9 November 2021; Revised 14 December 2021; Accepted 6 January 2022; Published 22 January 2022 Academic Editor: Yuichiro Maekawa Copyright © 2022 Jeong Hun Seo et al. -is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Total ischemic time (TIT) is an important factor for predicting mortality among patients with ST-segment elevation myocardial infarction (STEMI). However, the correlation between TIT and the extent of wall motion abnormality has not been well studied. -erefore, we investigated changes in the wall motion score index (WMSI) value based on TIT in STEMI patients who underwent primary percutaneous coronary intervention (PCI) and subsequent transthoracic echocardiography. Methods. STEMI patients who underwent primary PCI and follow-up coronary angiography were analyzed after the exclusion of cases of in- stent restenosis (ISR). WMSI values were calculated by dividing the sum of scores by the number of segments visualized. Results. A total of 189 patients underwent primary PCI for STEMI, and 151 had no ISR with a median follow-up of 12.3 months. TIT was 180 (117–369) minutes in a subset of 151 patients (mean age of 62 years; 76% male). Among patients without ISR, 109 (72%) demonstrated a decrease in the WMSI value during the follow-up period. -e WMSI values of patients with TITs of 180 minutes or less were significantly decreased relative to those among patients with TITs of greater than 180 minutes (p � 0.020). Among patients with TITs of 180 minutes or less, the TIT was significantly shorter among those with a reduction in the WMSI value than among those with an increase in the WMSI value (106 [81–124] vs. 133 [100–151] minutes; p � 0.018). TIT was an independent predictor for a reduction in the WMSI value among these patients (adjusted hazard ratio: 0.976 (0.957–0.995); p � 0.016). Conclusions. In the modern reperfusion era of STEMI, patients with TITs of 180 minutes or less experienced a significant degree of recovery from regional wall motion abnormalities. -e longer the artery is occluded, the more the 1. Introduction wavefront of ischemia extends radially from the endo- Timely primary percutaneous coronary intervention (PCI) is cardium to the epicardium [6]. Importantly, the trans- the current preferred strategy to treat ST-segment elevation mural extent and overall size of the infarction are myocardial infarction (STEMI) [1]. -e maximum myo- independently predictive of cardiac prognosis in the longer cardial salvage gained from reperfusion therapy is generally term [7]. Several studies have provided evidence that accepted to occur within the first few hours of symptom primary PCI improves left ventricular (LV) dysfunction onset, and the potential for salvaging myocardium is con- and inhibits postinfarction dilation and remodeling [8, 9]. sidered minimal or absent after this time. [2, 3]. Although However, little data are available concerning the corre- the data remain somewhat controversial, the bulk of the lation between TIT and the extent of wall motion ab- evidence also suggests that prolonged total ischemic times normality. In addition, although shorter TITs are better, (TITs), times from symptom onset to balloon inflation, are the limitations of the optimal TIT are unclear. -erefore, associated with an increased risk of mortality [4, 5]. we sought to investigate changes in the wall motion score 2 Journal of Interventional Cardiology inflation. Information on the timing of symptom onset was index (WMSI) value based on the TIT in STEMI patients who underwent primary PCI and subsequent transthoracic obtained by patient interviews. -e times of emergency department arrival and first balloon inflation were obtained echocardiography (TTE). from patients’ medical records. 2. Methods 2.5. Echocardiography and WMSI. Comprehensive TTE was 2.1. Study Population. We identified all patients with STEMI performed on commercially available equipment (Vivid E9; who underwent primary PCI between September 2010 and GE Healthcare, Milwaukee, WI, USA or Acuson SC2000; September 2020 at a single center. Among these patients, we Siemens Medical Solutions, Mountain View, CA, USA). screened patients who underwent both follow-up coronary Standard M-mode, two-dimensional, and color Doppler angiography (CAG) and TTE. Patients who experienced imaging were performed in parasternal, suprasternal, sub- death in or out of the hospital as well as those with follow-up sternal, and apical views with positional adjustment of the loss, only CAG or TTE performed at follow-up, or in-stent patients. -e initial TTE was performed within 24 hours restenosis (ISR) were excluded. A total of 151 patients were after primary PCI. -e initial and follow-up echocardio- finally analyzed in this study (Figure 1) and were stratified as grams recorded during the study period were used to those with a decrease and those with an increase in the evaluate echocardiographic changes. -e median interval of WMSI value during the follow-up period. -is study was echocardiography was 12.3 months [interquartile range approved by the Kangwon National University Hospital (IQR): 12.1–13.6 months]. Anatomic measurements were Institutional Ethics Committee/Review Board (Study no. made according to the American Society of Echocardiog- 2018-12-004). Informed consent was waived because of the raphy (ASE) guidelines [12]. WMSI values were obtained by retrospective nature of the study. dividing the LV into 16 segments from multiple short-axis views, and apical two-, four-, and long-axis views. -is 16- segment model consists of six segments at both the basal and 2.2. Clinical Data Collection. Demographic and clinical mid-ventricular levels and four segments at the apex. -e characteristics of patients with STEMI, including age, sex, attachment of the right ventricular wall to the left ventricle medical history, Killip class, peak cardiac troponin I and defines the septum, which is divided at basal and mid-left creatine kinase-MB (CK-MB) isoenzyme levels, lipid pro- ventricular levels into anteroseptum and inferoseptum. files, and serum creatinine and hemoglobin concentrations, Continuing counterclockwise, the remaining segments at were recorded. Angiographic characteristics of interest in- both basal and mid-ventricular levels are labeled as inferior, cluded the number of diseased vessels and culprit lesions. In inferolateral, anterolateral, and anterior. -e apex includes addition, data on medical therapies administered during septal, inferior, lateral, and anterior segments. Each segment hospitalization were collected. was analyzed individually and scored on the basis of its motion and systolic thickening. Each of the segments was 2.3. STEMI and Primary PCI. STEMI was diagnosed and assigned a score based on the degree of myocardial thick- treated in accordance with the most recent guidelines ening as follows: one point, normally contracting segment [10, 11]. Briefly, STEMI was defined as a new ST-segment (or hyperkinetic segment); two points, hypokinesis; three elevation of greater than 0.1 mV on at least two contiguous points, akinesis; four points, dyskinesis; and five points, electrocardiographic leads or the presence of left bundle aneurysm. -e WMSI value was calculated by dividing the branch block in patients with acute myocardial infarction. sum of scores by the number of segments visualized. Left Experienced interventional cardiologists performed primary ventricular measurements and wall motion abnormalities of PCI in all eligible patients with STEMI. Routine medical all patients were reviewed by 2 independent cardiologists. therapies administered during the perioperative period -e observers were blinded to one another’s WMSI mea- consisted of aspirin, P2Y12 inhibitors (e.g., clopidogrel, surements and the clinical endpoint. prasugrel, ticagrelor), heparin (either low molecular weight or conventional), and/or glycoprotein IIb/IIIa receptor 2.6. Statistical Analysis. Continuous variables were reported antagonists. In addition, secondary preventive therapies, as mean± standard deviation values and were compared including statins, β-blockers, angiotensin-converting en- using Welch’s t-test or the Wilcoxon rank-sum test, as zyme inhibitors, or angiotensin receptor blockers, were appropriate. Categorical variables were summarized by indicated for all patients with STEMI in the absence of frequencies or percentages and analyzed with the chi- contraindications. squared test or Fisher’s exact test, as appropriate. Changes in the WMSI value were analyzed with the paired t-test. 2.4. TIT. -e TIT was defined as the time from the onset of Stepwise multiple linear regression analysis was used to identify the independent predictors of reductions in the chest pain to the first occurrence of balloon inflation during primary PCI. -is period consisted of onset-to-door and WMSI value. All statistical tests were two-tailed, and p values of less than 0.05 were considered statistically significant. All door-to-balloon times. Onset-to-door time was defined as the time from symptom onset to emergency department analyses were performed using the Statistical Package for the Social Sciences version 25.0 statistical software (IBM Cor- arrival, whereas door-to-balloon time was the time from emergency department arrival to the first instance of balloon poration, Armonk, NY, USA). Journal of Interventional Cardiology 3 STEMI patients underwent primary PCI Sep 2010 ~ Sep 2020 (N = 522) Excluded: Death in hospital (n = 54) Death out of hospital (n = 15) Follow-up loss (n = 47) Only follow-up CAG or TTE (n = 217) STEMI patients with follow-up CAG & TTE (N = 189) Excluded: in-stent restenosis (n = 38) Study patients without ISR (N = 151) ∆WMSI ↓ ∆WMSI ↑ (N = 109) (N = 42) Figure 1: Patient flowchart. CAG � coronary angiography; ISR � in-stent restenosis; STEMI � ST-segment elevation myocardial infarction; TTE � transthoracic echocardiography; WMSI � wall motion score index. 3.3. Prediction of WMSI Value Reduction in Patients with TITs 3. Results of 180 Minutes or Less. In patients with TITs of 180 minutes 3.1. Baseline Characteristics and Echocardiography. or less, the TIT was significantly shorter among those with a Baseline characteristics of the patients according to changes in reduction in the WMSI value than among those with an WMSI value are summarized in Table 1. -ere were no sig- increase in the WMSI value (106 [81–124] vs. 133 [100–151] nificant differences in terms of age, sex, comorbidities (e.g., minutes, p � 0.018) (Table 3). In multivariate logistic re- diabetes and hypertension), STEMI location, or medication use gression analysis adjusted for age, sex, body mass index, between patients who experienced a decrease in WMSI value diabetes, hypertension, and smoking status, TIT was an and those who showed an increase in the WMSI value. -e total independent predictor for a decrease in the WMSI value door-to-balloon time and TIT were statistically indifferent among these patients (adjusted hazard ratio: 0.976 between the two groups. However, there were more patients (0.957–0.995); p � 0.016) (Table 4). with TITs of 120 minutes or less among those with a decrease in the WMSI value than among those with an increase in the 4. Discussion WMSI value (37 (34%) vs. 7 (17%); p � 0.036). Among the laboratory findings, peak CK-MB was lower in the group of In this study, we evaluated changes in the WMSI value based patients with WMSI value reductions. -e LV end-diastolic on TIT in STEMI patients who underwent primary PCI and dimension was greater in patients with a decrease in the WMSI subsequent transthoracic echocardiography. -e major value than those with an increase in the WMSI value (Table 2). findings of this study were as follows: (1) WMSI values in patients with TITs of 180 minutes or less were significantly 3.2. Changes in WMSI Value Based on TIT. Figure 2 shows decreased relative to those in patients with TITs of greater the changes in the WMSI value according to TIT. -ere were than 180 minutes during the follow-up period; (2) in patients no significant changes in the WMSI value between the two with TITs of 180 minutes or less, the TIT was significantly groups based on TITs of 120 and 210 minutes; however, WMSI shorter among the subset with a decrease in the WMSI value values in patients with TITs of 150 minutes or less and 180 than those with an increase in the WMSI value; and (3) TIT minutes or less were significantly decreased relative to those of was an independent predictor for recovery from regional patients with TITs of greater than 150 minutes and greater wall motion abnormalities in patients with TITs of 180 than 180 minutes (p � 0.049 and p � 0.020, respectively). minutes or less. 4 Journal of Interventional Cardiology Table 1: Baseline characteristics. DWMSI↓ (n � 109) DWMSI↑ (n � 42) p value Demographics Age, years 62± 13 61± 10 0.565 Male 82 (75) 33 (79) 0.666 Body mass index, kg/m 24.1± 3.0 24.5± 3.0 0.484 Medical history Diabetes 36 (33) 12 (29) 0.598 Hypertension 52 (48) 24 (57) 0.299 Smoking ever 52 (48) 21 (50) 0.800 Previous stroke 6 (5.5) 1 (2.4) 0.413 Previous PCI 7 (6.4) 0 (0.0) 0.093 Clinical presentation Preinfarction angina 7 (6.4) 4 (9.5) 0.511 STEMI location Anterior 57 (52) 13 (31) Inferior 44 (40) 24 (57) 0.075 Lateral 5 (4.6) 5 (12) Posterior 2 (1.8) 0 (0.0) Killip class I 74 (68) 32 (76) II 17 (16) 7 (17) 0.521 III 5 (4.6) 1 (2.4) IV 13 (12) 2 (4.8) Culprit vessels Left main coronary artery 1 (0.9) 0 (0.0) Left anterior descending artery 69 (63) 15 (36) 0.010 Left circumflex artery 5 (4.6) 6 (14) Right coronary artery 34 (31) 21 (50) Extent of CAD 1VD 86 (79) 38 (91) 2VD 20 (18) 3 (7.1) 0.222 3VD 3 (2.8) 1 (2.4) TIMI flow Grade 2 10 (9.2) 4 (9.5) 0.947 Grade 3 99 (91) 38 (90) De novo lesions at follow-up CAG 16 (15) 4 (9.5) 0.402 Door-to-balloon time, minutes 49 (38–62) 48 (36–59) 0.453 Total ischemic time, minutes 178 (105–368) 204 (133–372) 0.232 Group according to total ischemic time (TIT) ≤120 minutes 37 (34) 7 (17) 0.036 120–150 minutes 10 (9.2) 7 (17) 0.192 150–180 minutes 8 (7.3) 5 (12) 0.370 180–210 minutes 7 (6.4) 4 (9.5) 0.511 >210 minutes 47 (43) 19 (45) 0.814 Medications Aspirin 109 (100) 42 (100) — Clopidogrel 92 (84) 31 (74) 0.133 Ticagrelor 4 (3.7) 4 (9.5) 0.150 Prasugrel 14 (13) 8 (19) 0.333 Cilostazol 19 (17) 8 (19) 0.816 Statin 109 (100) 42 (100) — β-Blockers 93 (85) 37 (88) 0.659 ACE inhibitor 24 (22) 11 (26) 0.586 Angiotensin II receptor blocker 57 (52) 19 (45) 0.437 Laboratory assessments Hemoglobin, g/dL 14.4± 2.1 14.3± 2.4 0.759 CRP, mg/dL 0.99± 3.0 0.55± 1.5 0.370 BUN, g/dL 15.4± 5.3 14.8± 5.8 0.521 Creatinine, g/dL 0.89± 0.25 0.88± 0.28 0.785 Glucose, mg/dL 173± 79 161± 48 0.346 HbA1c, % 6.8± 1.8 6.4± 1.2 0.171 Journal of Interventional Cardiology 5 Table 1: Continued. DWMSI↓ (n � 109) DWMSI↑ (n � 42) p value Total cholesterol, mg/dL 177± 45 180± 50 0.723 LDL, mg/dL 118± 49 116± 51 0.860 CK-MB, ng/mL 147± 110 213± 109 0.001 Troponin I, pg/mL 30.4± 34.3 34.8± 21.3 0.440 BNP, pg/mL 104± 199 138± 209 0.382 Values are presented as mean± standard deviation, n (%), or median (interquartile range). ACE, angiotensin-converting enzyme; BNP, brain natriuretic peptide; BUN, blood urea nitrogen; CAD, coronary artery disease; CAG, coronary angiography; CK-MB, creatine kinase-MB fraction; CRP, C-reactive protein; HbA1c, hemoglobin A1c; LDL, low-density lipoprotein; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; TIMI, thrombolysis in myocardial infarction. Statistical significance was defined as p< 0.05 by Welch’s t-test (continuous variables) or the chi- squared test (categorical variables). -e values in bold indicate statistical significance (p < 0.05). Table 2: Echocardiographic parameters. ΔWMSI↓ (n � 109) ΔWMSI↑ (n � 42) p value LV end-diastolic dimension, mm 48.2± 4.1 50.0± 4.8 0.027 LV end-systolic dimension, mm 32.3± 4.5 34.0± 6.3 0.064 Interventricular septum thickness, mm 9.7± 1.4 9.8± 1.1 0.700 LV posterior wall thickness, mm 9.6± 1.2 9.9± 1.2 0.256 LV ejection fraction, % 51.9± 8.4 52.5± 8.7 0.669 LA volume index, ml/m 33.4± 11.4 33.9± 9.0 0.812 Early diastolic mitral inflow velocity (E), m/s 0.59± 0.19 0.65± 0.20 0.101 Late diastolic mitral inflow velocity (A), m/s 0.74± 0.18 0.76± 0.21 0.465 Mitral annulus early diastolic velocity (e′), m/s 0.06± 0.02 0.07± 0.07 0.477 E/e′ 10.8± 5.0 12.6± 5.9 0.064 RV systolic pressure, mm Hg 25.5± 8.5 25.8± 10.1 0.840 Values are presented as mean± standard deviation. LA, left atrium; LV, left ventricle; RV, right ventricle. Statistical significance was defined as p< 0.05 by Welch’s t-test (continuous variables). -e value in bold indicates statistical significance (p < 0.05). Timely performance of the primary PCI as measured by during hospital admission, such as malignant arrhythmia, pump failure, and mortality [25–27]. In addition, WMSI can door-to-balloon time has become one of the main quality measures in the treatment of patients with STEMI [13, 14]. be used to quantitatively measure the LV systolic function following STEMI [28]. Several studies have failed to report improvements in mortality with shortened door-to-balloon times [15, 16]. It is Two studies reported a significant improvement in possible that further reductions in the mortality rate of echocardiographic parameters, such as LVEF and WMSI, STEMI patients in the modern era of primary PCI and during follow-up after myocardial infarction [29, 30]. Such adjuvant pharmacotherapy may be achieved only by means improved echocardiographic findings may indicate that well- of reducing the TIT. Minimizing TIT is a major determinant timed and successful revascularization can restrict further of myocardial salvage, as the prolonged duration of ischemia myocardial remodeling. -e results of follow-up echocardi- is related to myocardial necrosis, as evidenced by cardiac ography performed approximately three months after the magnetic resonance (CMR) imaging [17]. Some of the new episode suggested that, following PCI, future wall motion improvement is highly dependent on how quickly it is possible imaging techniques, such as CMR and strain, are more precise for determining myocardial damage; however, they to reinstate perfusion in the occluded artery. In patients whose are less accessible techniques for daily practice. Some studies perfusion was restored earlier with PCI, the follow-up echo- have reported a good correlation between WMSI and cardiography reflected a significantly better degree of im- echocardiographic strain findings [18, 19]. LV ejection provement [30]. -e present study had a longer observation fraction (LVEF) improves in some STEMI patients after period than these two previous studies involving echocardi- effective reperfusion as a consequence of the gradual relief of ography and excluded cases of ISR through follow-up CAG; as myocardial stunning, whereas, in other patients, irreversible such, we could discern the relationship between TIT and myocardial necrosis may result in chronic LV dysfunction WMSI more clearly. Overall, in this study, the WMSI value tended to decrease regardless of TIT (Figure 2). However, [20]. Reverse LV remodeling occurred in a considerable proportion (37.7%) of STEMI patients who underwent patients who underwent primary PCI within 180 minutes experienced a more significant decrease in the WMSI value primary PCI, manifesting a poor prognosis [20, 21]. -e LVEF value is technique-dependent and may not accurately than those who underwent primary PCI after 180 minutes. indicate the extent of myocardial damage due to regional -is result suggests that there is an optimal TIT within which compensatory effects [22–24]. On the other hand, it is es- better outcomes in STEMI patients may be achieved. timated that an increase in the WMSI value within the first In 1977, transient left circumflex coronary artery ligation 12 to 24 hours after STEMI is a predictor of complications was performed in dogs for different durations [31]. -e 6 Journal of Interventional Cardiology P = 0.112 **P = 0.049 * * 1.5 1.5 1.38±0.26 1.38±0.24 1.36±0.21 1.34±0.20 1.4 1.4 1.27±0.26 1.26±0.26 1.3 1.3 1.19±0.23 1.17±0.22 1.2 1.2 1.1 1.1 1.0 1.0 TIT ≤ 120 min TIT > 120 min TIT ≤ 150 min TIT > 150 min Initial WMSI Initial WMSI Follow–up WMSI Follow–up WMSI (a) (b) **P = 0.020 P = 0.064 * * 1.5 1.5 1.40±0.25 1.39±0.25 1.35±0.21 1.4 1.34±0.21 1.4 1.30±0.27 1.29±0.27 1.3 1.3 1.18±0.22 1.19±0.22 1.2 1.2 1.1 1.1 1.0 1.0 TIT ≤ 180 min TIT > 180 min TIT ≤ 210 min TIT > 210 min Initial WMSI Initial WMSI Follow–up WMSI Follow–up WMSI (c) (d) Figure 2: Changes in the WMSI value based on TITs of (a) 120, (b) 150, (c) 180, and (d) 210 minutes. TIT �total ischemic time; WMSI � wall motion score index. Table 3: Variables associated with a decrease in the WMSI value among patients with TITs of 180 minutes or less (N � 74). ΔWMSI↓(n � 55) ΔWMSI↑(n � 19) p value Age 61± 14 61± 11 0.971 Male sex 44 (80) 14 (74) 0.564 Body mass index 24.2± 2.8 25.2± 3.1 0.188 Diabetes 14 (26) 7 (37) 0.343 Hypertension 27 (49) 12 (63) 0.290 Smoking ever 26 (47) 6 (32) 0.234 STEMI, anterior 29 (53) 7 (37) 0.232 Total ischemic time, minutes 106 (81–124) 133 (100–151) 0.018 CK-MB 134± 103 168± 113 0.244 LV end-diastolic dimension, mm 47.9± 3.9 49.1± 5.7 0.301 Values are presented as mean± standard deviation, n (%), or median (interquartile range). CK-MB, creatine kinase-MB fraction; LV, left ventricle; STEMI, ST-segment elevation myocardial infarction. Statistical significance was defined as p< 0.05 by Welch’s t-test (continuous variables) or the chi-squared test (categorical variables). -e values in bold indicate statistical significance (p < 0.05). percentage of transmural necrosis increased from 38% at 40 when evaluating cardiovascular outcomes in STEMI patients minutes of circumflex artery ligation duration to 85% at 24 receiving fibrinolysis. For every 1,000 patients, 15 more lives hours of duration. Similar results have also been reported were saved at one month of follow-up if the patients received WMSI WMSI WMSI WMSI Journal of Interventional Cardiology 7 Table 4: Predictor of a decrease in the WMSI value among patients with TITs of 180 minutes or less. Univariate Multivariate OR (95% CI) p value OR (95% CI) p value Total ischemic time, minutes 0.980 (0.964–0.997) 0.023 0.976 (0.957–0.995) 0.016 Adjusted for age, sex, body mass index, diabetes, hypertension, and smoking status. treatment an hour earlier in the European Myocardial In- suffering from pain and stress. -erefore, symptom-to- balloon times may not have been independently verified. farction Project Group [32]. A meta-analysis of 22 ran- domized controlled trials studied more than 50,000 STEMI patients who received fibrinolysis. If fibrinolysis was 5. Conclusion achieved within one hour of symptom onset, there were 65 In the modern reperfusion era of STEMI, patients with TITs fewer deaths for every 1,000 patients when compared to of 180 minutes or less showed a significant degree of re- patients who experienced greater delays from symptom covery from regional wall motion abnormalities compared onset to fibrinolysis [33]. Both animal and clinical data to those with TITs of greater than 180 minutes. Every support the notion that shortening the duration of infarct possible effort should be made to reduce TIT to 180 minutes artery occlusions can lead to smaller infarct sizes and lower or less, and further treatment for patients with TITs of mortality rates. However, the relationship is not linear and greater than 180 minutes should be considered. most of the benefit of reperfusion is seen within the first two hours of occlusion. In the CMR study, patients with a symptom-to-balloon time of greater than 121 minutes had Abbreviations significantly greater transmural necrosis, a larger infarct size, CMR: Cardiac magnetic resonance and decreased myocardial salvage [34]. -e current guide- LV: Left ventricle lines recommend primary PCI as the preferred reperfusion PCI: Percutaneous coronary intervention strategy over thrombolysis in patients with STEMI, provided STEMI: ST-segment elevation myocardial infarction it can be performed within 120 minutes from STEMI di- TIT: Total ischemic time agnosis [10]. -is would correspond with prolonged WMSI: Wall motion score index. symptom-onset-to-balloon times of 3 to 4 hours. Of 1,791 patients with STEMI treated by primary angioplasty, a Data Availability symptom-onset-to-balloon time of more than four hours was an independent predictor of one-year mortality [35]. In -e data used to support the findings of this study are the Acute Coronary Syndrome Israeli Survey registry (in- available from the corresponding author upon reasonable volving 2,254 patients with STEMI treated by primary PCI), request. shortening of the TIT to less than 150 minutes was associated with improved long-term survival rates [36]. In the current Disclosure study, based on a TIT of 180 minutes, a significant reduction in the WMSI value was experienced within a median follow- nd -is study was presented in the conference “-e 72 Fall up period of 1 year. -is result may explain why the optimal Conference of the Korean Society of Internal Medicine TIT exceeds two hours in clinical studies conducted in the 2021.” modern reperfusion era of STEMI. -ere were significant changes in the WMSI value based on TITs of 150 and 180 Conflicts of Interest minutes; especially considering a TIT of 180 minutes, TIT was an independent predictor of recovery from regional wall -e authors declare no conflicts of interest. motion abnormalities. -is study is meaningful in sug- gesting the criteria for the optimal TIT based on the WMSI References value in STEMI patients. ´ ´ [1] R. Estevez-Loureiro, A. Lopez-Sainz, and A. 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Journal
Journal of Interventional Cardiology – Hindawi Publishing Corporation
Published: Jan 22, 2022