Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction

Björn Redfors; Reza Mohebi; Gennaro Giustino; Shmuel Chen; Harry P. Selker; Holger Thiele; Manesh R. Patel; James E. Udelson; E. Magnus Ohman; Ingo Eitel; Christopher B. Granger; Akiko Maehara; Ziad A. Ali; Ori Ben-Yehuda; Gregg W. Stone

doi:10.1161/CIRCINTERVENTIONS.120.009879

Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction

Björn Redfors, Reza Mohebi, Gennaro Giustino, Shmuel Chen, Harry P. Selker, Holger Thiele, Manesh R. Patel, James E. Udelson, E. Magnus Ohman, Ingo Eitel, Christopher B. Granger, Akiko Maehara, Ziad A. Ali, Ori Ben-Yehuda, Gregg W. Stone^*

^*Corresponding author for this work

Clinic of Internal Medicine II - Cardiology

55 Citations (Scopus)

Abstract

Background: Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment-elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. Methods: Individual patient data for 3115 ST-segment-elevation myocardial infarction patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99 m sestamibi single-photon emission computerized tomography (3 studies) or cardiac magnetic resonance imaging (7 studies). MVO was assessed by cardiac magnetic resonance. Patients were stratified by short (≤2 hours), intermediate (2-4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45-90 minutes), or long (>90 minutes) DBTs. Results: Median [interquartile range] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [interquartile range] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference, 2.0% [95% CI, 0.4-3.5] for intermediate versus short SBT and 4.4% [95% CI, 2.7-6.1] for long versus short SBT) but not according to DBT category (adjusted difference, 0.4% [95% CI, -1.2 to 1.9] for intermediate versus short DBT and -0.1% [95% CI, -1.0 to 3.0] for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference, 0.9% [95% CI, 0.3-1.4]) but was not different between patients with intermediate versus short SBT (adjusted difference, 0.1 [95% CI, -0.4 to 0.6]). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. Conclusions: Among 3115 patients with ST-segment-elevation myocardial infarction undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.

Original language	English
Journal	Circulation: Cardiovascular Interventions
Volume	14
Issue number	2
Pages (from-to)	E009879
ISSN	1941-7640
DOIs	https://doi.org/10.1161/CIRCINTERVENTIONS.120.009879
Publication status	Published - 01.02.2021

Funding

Dr Giustino reports consultant fees (advisory board) from Bristol Myers Squibb (BMS)/Pfizer. Dr Patel reports research grants from Bayer, Janssen, HeartFlow, National Heart, Lung, and Blood Institute; advisory board/consulting: AstraZen-eca, Bayer, Janssen, HeartFlow. Dr Udelson reports the following: Trial Steering Committee—Abiomed; consultant—Imbria Pharmaceuticals. Dr Ohman reports research grants from Abiomed, Chiesi, Portola and is a consultant at Abiomed, Cara Therapeutics, Genentech, Imbria Pharmaceuticals, Impulse Dynamics, Janssen Pharmaceuticals, Medtronic, Medscape, Milestone Pharmaceuticals, XyloCor Therapeutics. Dr Granger reports research grants from AstraZeneca, Food and Drug Administration, NIH, GSK, Medtronic, Novartis, Apple, Boehringer Ingelheim, BMS/Pfizer, Janssen. Consulting: AstraZeneca, Espero, GSK, Medtronic, Novartis, Boehringer Ingelheim, Boston Scientific, BMS/Pfizer, Daiichi Sankyo, Merck, Roche, Eli Lilly, The Medicine’s Company, Janssen. Dr Maehara reports grant support and consultant for Abbott Vascular and Boston Scientific. Dr Ali reports institutional research grants to Columbia University— Abbott, Cardiovascular Systems, Inc and is a consultant at Amgen, AstraZene-ca, and Boston Scientific and equity in Shockwave. Dr Stone receives honoraria from Cook, Terumo, Qool Therapeutics, and Orchestra Biomed; Consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Matrizyme; Equity/options from Ancora, Qool Therapeutics, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, MedFocus family of funds, Valfix. The other authors report no conflicts.

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Research Areas and Centers

Centers: Cardiological Center Luebeck (UHZL)

DFG Research Classification Scheme

2.22-12 Cardiology, Angiology

Access to Document

10.1161/CIRCINTERVENTIONS.120.009879

Cite this

Redfors, B., Mohebi, R., Giustino, G., Chen, S., Selker, H. P., Thiele, H., Patel, M. R., Udelson, J. E., Ohman, E. M., Eitel, I., Granger, C. B., Maehara, A., Ali, Z. A., Ben-Yehuda, O., & Stone, G. W. (2021). Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction. Circulation: Cardiovascular Interventions, 14(2), E009879. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009879

@article{2f554f27fc8444dea9516e6bd094c45b,

title = "Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction",

abstract = "Background: Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment-elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. Methods: Individual patient data for 3115 ST-segment-elevation myocardial infarction patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (\% left ventricular mass) was assessed within 1 month after randomization by technetium-99 m sestamibi single-photon emission computerized tomography (3 studies) or cardiac magnetic resonance imaging (7 studies). MVO was assessed by cardiac magnetic resonance. Patients were stratified by short (≤2 hours), intermediate (2-4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45-90 minutes), or long (>90 minutes) DBTs. Results: Median [interquartile range] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [interquartile range] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference, 2.0\% [95\% CI, 0.4-3.5] for intermediate versus short SBT and 4.4\% [95\% CI, 2.7-6.1] for long versus short SBT) but not according to DBT category (adjusted difference, 0.4\% [95\% CI, -1.2 to 1.9] for intermediate versus short DBT and -0.1\% [95\% CI, -1.0 to 3.0] for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference, 0.9\% [95\% CI, 0.3-1.4]) but was not different between patients with intermediate versus short SBT (adjusted difference, 0.1 [95\% CI, -0.4 to 0.6]). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. Conclusions: Among 3115 patients with ST-segment-elevation myocardial infarction undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.",

author = "Bj{\"o}rn Redfors and Reza Mohebi and Gennaro Giustino and Shmuel Chen and Selker, \{Harry P.\} and Holger Thiele and Patel, \{Manesh R.\} and Udelson, \{James E.\} and Ohman, \{E. Magnus\} and Ingo Eitel and Granger, \{Christopher B.\} and Akiko Maehara and Ali, \{Ziad A.\} and Ori Ben-Yehuda and Stone, \{Gregg W.\}",

year = "2021",

month = feb,

day = "1",

doi = "10.1161/CIRCINTERVENTIONS.120.009879",

language = "English",

volume = "14",

pages = "E009879",

journal = "Circulation: Cardiovascular Interventions",

issn = "1941-7640",

publisher = "Lippincott Williams and Wilkins",

number = "2",

}

Redfors, B, Mohebi, R, Giustino, G, Chen, S, Selker, HP, Thiele, H, Patel, MR, Udelson, JE, Ohman, EM, Eitel, I, Granger, CB, Maehara, A, Ali, ZA, Ben-Yehuda, O & Stone, GW 2021, 'Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction', Circulation: Cardiovascular Interventions, vol. 14, no. 2, pp. E009879. https://doi.org/10.1161/CIRCINTERVENTIONS.120.009879

Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction. / Redfors, Björn; Mohebi, Reza; Giustino, Gennaro et al.
In: Circulation: Cardiovascular Interventions, Vol. 14, No. 2, 01.02.2021, p. E009879.

Research output: Journal Articles › Journal articles › Research › peer-review

TY - JOUR

T1 - Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction

AU - Redfors, Björn

AU - Mohebi, Reza

AU - Giustino, Gennaro

AU - Chen, Shmuel

AU - Selker, Harry P.

AU - Thiele, Holger

AU - Patel, Manesh R.

AU - Udelson, James E.

AU - Ohman, E. Magnus

AU - Eitel, Ingo

AU - Granger, Christopher B.

AU - Maehara, Akiko

AU - Ali, Ziad A.

AU - Ben-Yehuda, Ori

AU - Stone, Gregg W.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - Background: Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment-elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. Methods: Individual patient data for 3115 ST-segment-elevation myocardial infarction patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99 m sestamibi single-photon emission computerized tomography (3 studies) or cardiac magnetic resonance imaging (7 studies). MVO was assessed by cardiac magnetic resonance. Patients were stratified by short (≤2 hours), intermediate (2-4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45-90 minutes), or long (>90 minutes) DBTs. Results: Median [interquartile range] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [interquartile range] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference, 2.0% [95% CI, 0.4-3.5] for intermediate versus short SBT and 4.4% [95% CI, 2.7-6.1] for long versus short SBT) but not according to DBT category (adjusted difference, 0.4% [95% CI, -1.2 to 1.9] for intermediate versus short DBT and -0.1% [95% CI, -1.0 to 3.0] for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference, 0.9% [95% CI, 0.3-1.4]) but was not different between patients with intermediate versus short SBT (adjusted difference, 0.1 [95% CI, -0.4 to 0.6]). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. Conclusions: Among 3115 patients with ST-segment-elevation myocardial infarction undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.

AB - Background: Symptom-to-balloon time (SBT) and door-to-balloon time (DBT) are both considered important metrics in patients undergoing primary percutaneous coronary intervention (pPCI) for ST-segment-elevation myocardial infarction (STEMI). We sought to assess the relationship of SBT and DBT with infarct size and microvascular obstruction (MVO) after pPCI. Methods: Individual patient data for 3115 ST-segment-elevation myocardial infarction patients undergoing pPCI in 10 randomized trials were pooled. Infarct size (% left ventricular mass) was assessed within 1 month after randomization by technetium-99 m sestamibi single-photon emission computerized tomography (3 studies) or cardiac magnetic resonance imaging (7 studies). MVO was assessed by cardiac magnetic resonance. Patients were stratified by short (≤2 hours), intermediate (2-4 hours), or long (>4 hours) SBTs, and by short (≤45 minutes), intermediate (45-90 minutes), or long (>90 minutes) DBTs. Results: Median [interquartile range] SBT and DBT were 185 [130-269] and 46 [28-83] minutes, respectively. Median [interquartile range] time to infarct size assessment after pPCI was 5 [3-12] days. There was a stepwise increase in infarct size according to SBT category (adjusted difference, 2.0% [95% CI, 0.4-3.5] for intermediate versus short SBT and 4.4% [95% CI, 2.7-6.1] for long versus short SBT) but not according to DBT category (adjusted difference, 0.4% [95% CI, -1.2 to 1.9] for intermediate versus short DBT and -0.1% [95% CI, -1.0 to 3.0] for long versus short SBT). MVO was greater in patients with long versus short SBT (adjusted difference, 0.9% [95% CI, 0.3-1.4]) but was not different between patients with intermediate versus short SBT (adjusted difference, 0.1 [95% CI, -0.4 to 0.6]). There was no difference in MVO according to DBT. Results were similar in multivariable analysis with SBT and DBT included as continuous variables. Conclusions: Among 3115 patients with ST-segment-elevation myocardial infarction undergoing infarct size assessment after pPCI, SBT was more strongly correlated with infarct size and MVO than DBT.

UR - https://www.scopus.com/pages/publications/85102211897

U2 - 10.1161/CIRCINTERVENTIONS.120.009879

DO - 10.1161/CIRCINTERVENTIONS.120.009879

M3 - Journal articles

C2 - 33440999

AN - SCOPUS:85102211897

SN - 1941-7640

VL - 14

SP - E009879

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

IS - 2

ER -

Time Delay, Infarct Size, and Microvascular Obstruction After Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Myocardial Infarction

Abstract

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UN SDGs

Research Areas and Centers

DFG Research Classification Scheme

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