Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction

Lars Nepper-Christensen; Jacob Lønborg; Dan E Høfsten; Kiril A Ahtarovski; Lia E Bang; Steffen Helqvist; Kasper Kyhl; Lars Køber; Henning Kelbæk; Niels Vejlstrup; Lene Holmvang; Thomas Engstrøm

doi:10.1161/CIRCINTERVENTIONS.118.006842

Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction

Lars Nepper-Christensen, Jacob Lønborg, Dan E Høfsten, Kiril A Ahtarovski, Lia E Bang, Steffen Helqvist, Kasper Kyhl, Lars Køber, Henning Kelbæk, Niels Vejlstrup, Lene Holmvang, Thomas Engstrøm

41 Citations (Scopus)

Abstract

BACKGROUND: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting <12 hours.

METHODS AND RESULTS: We included 865 STEMI patients who underwent cardiac magnetic resonance just after index PCI and 3 months later. Despite equal area at risk (34±12% versus 33±12%; P=0.370), patients presenting late (n=58) had larger final infarct size (13% [interquartile range, 9-24] versus 11% [interquartile range, 4-19]; P=0.037) and smaller myocardial salvage index (0.58 [interquartile range, 0.39-0.71] versus 0.65 [interquartile range, 0.49-0.84]; P=0.021) compared with patients presenting <12 hours after symptom onset (n=807). However, 65% of late-presenting patients achieved substantial myocardial salvage ≥0.50, and area under the curve for symptom onset to PCI as predictor of a myocardial salvage index ≥0.50 was poor (0.58 [95% CI, 0.53-0.63]; P<0.001). In addition, final infarct size, salvage index and left ventricular function correlated weakly with duration from symptom onset to primary PCI ( R2 values <0.05).

CONCLUSIONS: STEMI patients with signs of ongoing ischemia treated with primary PCI 12 to 72 hours after symptom onset had less myocardial salvage and developed larger infarcts. However, a large proportion achieved substantial myocardial salvage indicating a benefit from primary PCI in late-presenting patients.

CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01435408 and NCT01960933.

Original language	English
Journal	Circulation. Cardiovascular interventions
Volume	11
Issue number	9
Pages (from-to)	e006842
ISSN	1941-7640
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.118.006842
Publication status	Published - Sept 2018

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Nepper-Christensen, L., Lønborg, J., Høfsten, D. E., Ahtarovski, K. A., Bang, L. E., Helqvist, S., Kyhl, K., Køber, L., Kelbæk, H., Vejlstrup, N., Holmvang, L., & Engstrøm, T. (2018). Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction. Circulation. Cardiovascular interventions, 11(9), e006842. https://doi.org/10.1161/CIRCINTERVENTIONS.118.006842

Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction. / Nepper-Christensen, Lars ; Lønborg, Jacob ; Høfsten, Dan E et al.
In: Circulation. Cardiovascular interventions, Vol. 11, No. 9, 09.2018, p. e006842.

Research output: Contribution to journal › Journal article › Research › peer-review

Nepper-Christensen, L , Lønborg, J , Høfsten, DE , Ahtarovski, KA , Bang, LE , Helqvist, S , Kyhl, K , Køber, L, Kelbæk, H, Vejlstrup, N , Holmvang, L & Engstrøm, T 2018, 'Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction', Circulation. Cardiovascular interventions, vol. 11, no. 9, pp. e006842. https://doi.org/10.1161/CIRCINTERVENTIONS.118.006842

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title = "Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction",

abstract = "BACKGROUND: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting <12 hours.METHODS AND RESULTS: We included 865 STEMI patients who underwent cardiac magnetic resonance just after index PCI and 3 months later. Despite equal area at risk (34±12\% versus 33±12\%; P=0.370), patients presenting late (n=58) had larger final infarct size (13\% [interquartile range, 9-24] versus 11\% [interquartile range, 4-19]; P=0.037) and smaller myocardial salvage index (0.58 [interquartile range, 0.39-0.71] versus 0.65 [interquartile range, 0.49-0.84]; P=0.021) compared with patients presenting <12 hours after symptom onset (n=807). However, 65\% of late-presenting patients achieved substantial myocardial salvage ≥0.50, and area under the curve for symptom onset to PCI as predictor of a myocardial salvage index ≥0.50 was poor (0.58 [95\% CI, 0.53-0.63]; P<0.001). In addition, final infarct size, salvage index and left ventricular function correlated weakly with duration from symptom onset to primary PCI ( R2 values <0.05).CONCLUSIONS: STEMI patients with signs of ongoing ischemia treated with primary PCI 12 to 72 hours after symptom onset had less myocardial salvage and developed larger infarcts. However, a large proportion achieved substantial myocardial salvage indicating a benefit from primary PCI in late-presenting patients.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01435408 and NCT01960933.",

author = "Lars Nepper-Christensen and Jacob L{\o}nborg and H{\o}fsten, \{Dan E\} and Ahtarovski, \{Kiril A\} and Bang, \{Lia E\} and Steffen Helqvist and Kasper Kyhl and Lars K{\o}ber and Henning Kelb{\ae}k and Niels Vejlstrup and Lene Holmvang and Thomas Engstr{\o}m",

year = "2018",

month = sep,

doi = "10.1161/CIRCINTERVENTIONS.118.006842",

language = "English",

volume = "11",

pages = "e006842",

journal = "Circulation. Cardiovascular interventions",

issn = "1941-7640",

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TY - JOUR

T1 - Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction

AU - Nepper-Christensen, Lars

AU - Lønborg, Jacob

AU - Høfsten, Dan E

AU - Ahtarovski, Kiril A

AU - Bang, Lia E

AU - Helqvist, Steffen

AU - Kyhl, Kasper

AU - Køber, Lars

AU - Kelbæk, Henning

AU - Vejlstrup, Niels

AU - Holmvang, Lene

AU - Engstrøm, Thomas

PY - 2018/9

Y1 - 2018/9

N2 - BACKGROUND: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting <12 hours.METHODS AND RESULTS: We included 865 STEMI patients who underwent cardiac magnetic resonance just after index PCI and 3 months later. Despite equal area at risk (34±12% versus 33±12%; P=0.370), patients presenting late (n=58) had larger final infarct size (13% [interquartile range, 9-24] versus 11% [interquartile range, 4-19]; P=0.037) and smaller myocardial salvage index (0.58 [interquartile range, 0.39-0.71] versus 0.65 [interquartile range, 0.49-0.84]; P=0.021) compared with patients presenting <12 hours after symptom onset (n=807). However, 65% of late-presenting patients achieved substantial myocardial salvage ≥0.50, and area under the curve for symptom onset to PCI as predictor of a myocardial salvage index ≥0.50 was poor (0.58 [95% CI, 0.53-0.63]; P<0.001). In addition, final infarct size, salvage index and left ventricular function correlated weakly with duration from symptom onset to primary PCI ( R2 values <0.05).CONCLUSIONS: STEMI patients with signs of ongoing ischemia treated with primary PCI 12 to 72 hours after symptom onset had less myocardial salvage and developed larger infarcts. However, a large proportion achieved substantial myocardial salvage indicating a benefit from primary PCI in late-presenting patients.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01435408 and NCT01960933.

AB - BACKGROUND: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting <12 hours.METHODS AND RESULTS: We included 865 STEMI patients who underwent cardiac magnetic resonance just after index PCI and 3 months later. Despite equal area at risk (34±12% versus 33±12%; P=0.370), patients presenting late (n=58) had larger final infarct size (13% [interquartile range, 9-24] versus 11% [interquartile range, 4-19]; P=0.037) and smaller myocardial salvage index (0.58 [interquartile range, 0.39-0.71] versus 0.65 [interquartile range, 0.49-0.84]; P=0.021) compared with patients presenting <12 hours after symptom onset (n=807). However, 65% of late-presenting patients achieved substantial myocardial salvage ≥0.50, and area under the curve for symptom onset to PCI as predictor of a myocardial salvage index ≥0.50 was poor (0.58 [95% CI, 0.53-0.63]; P<0.001). In addition, final infarct size, salvage index and left ventricular function correlated weakly with duration from symptom onset to primary PCI ( R2 values <0.05).CONCLUSIONS: STEMI patients with signs of ongoing ischemia treated with primary PCI 12 to 72 hours after symptom onset had less myocardial salvage and developed larger infarcts. However, a large proportion achieved substantial myocardial salvage indicating a benefit from primary PCI in late-presenting patients.CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01435408 and NCT01960933.

UR - https://www.scopus.com/pages/publications/85055601009

U2 - 10.1161/CIRCINTERVENTIONS.118.006842

DO - 10.1161/CIRCINTERVENTIONS.118.006842

M3 - Journal article

C2 - 30354595

SN - 1941-7640

VL - 11

SP - e006842

JO - Circulation. Cardiovascular interventions

JF - Circulation. Cardiovascular interventions

IS - 9

ER -

Benefit From Reperfusion With Primary Percutaneous Coronary Intervention Beyond 12 Hours of Symptom Duration in Patients With ST-Segment-Elevation Myocardial Infarction

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