E.N. IVANTSOV, A.A. KHUSAINOVA, I.F. KHAMADULLINA, Z.F. KIM, N.R. KHASANOV

 Kazan State Medical University, Kazan

 Contact details:

Ivantsov E.N. — PhD (Medicine), Assistant Lecture of the Propaedeutics of Internal Diseases named after Prof. S.S. Zimnitskiy

Address: 49 Butlerov St., 420012 Kazan, Russian Federation, tel.: +7-958-620-44-86, e-mail: zhenia.iva91@gmail.com

ST-segment elevation myocardial infarction (STEMI) is an acute life-threatening condition that requires urgent, complex, well-coordinated treatment, aimed primarily at the earliest possible reperfusion. The adverse effect of delay to reperfusion on the prognosis of in-hospital mortality in patients with STEMI was demonstrated with both thrombolysis and PPCI in the 1996–2004 studies. More recent data are inconsistent regarding the association of adverse hospital outcomes with time to PPCI.

The purpose was to examine the time from the onset of pain in ST-segment elevation myocardial infarction to primary percutaneous coronary intervention in association with the hospitalization outcome.

Material and methods. For the study, we selected 177 records of patients with a fatal outcome and 380 records of patients discharged with a favorable outcome of myocardial infarction with ST-segment elevation from Kazan Emergency Care Center for patients with acute coronary syndrome. The study included 349 men and 208 women from 32 to 96 years old; the median age was 67 (58–76) years.

Results. The time from the onset of pain syndrome (PS) to the primary medical contact (PMC) in patients with a lethal and favorable outcome did not differ significantly and amounted to 180 (75–540) and 168 (88–450) minutes, respectively (p = 0.639). From the moment of PMC to the registration of the first ECG in patients with a fatal outcome, 26 (19–36) minutes passed, and in patients with a favorable outcome, 25 (17–40) minutes (p = 0.747). From the registration of the first ECG to hospitalization in patients with a fatal outcome, 42 (35–60) minutes passed, in patients with a favorable outcome 48 (40–60) minutes (p = 0.041). The time from hospitalization to primary PCI was 60 (45–104) minutes in patients with a fatal outcome and 60 (45–91) minutes in patients with a favorable outcome (p = 0.981).

Conclusion. In patients with STEMI, the time from the pain onset to the first medical contact, from the first medical contact to the first electrocardiogram, from the first electrocardiogram to the hospital door and from the hospital door to balloon inflation during PPCI does not differ significantly in patients with a favorable and fatal outcome.

Key words: myocardial infarction, time before applying for medical help, time from the pain onset to the first medical contact, hospital mortality in myocardial infarction.

REFERENCES

1. Partow-Navid R., Prasitlumkum N., Mukherjee A., Varadarajan P., Pai R.G. et al. Management of ST elevation myocardial infarction (STEMI) in different settings. J. Angiol, 2021, vol. 30 (1), pp. 67–75. DOI: 10.1055/s-0041-1723944
2. Keeley E.C., Boura J.A., Grines C.L. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet (London, England), 2003, vol. 361 (9351), pp. 13–20. DOI: 10.1016/S0140-6736(03)12113-7
3. Schömig A., Ndrepepa G., Kastrati A. Late myocardial salvage: time to recognize its reality in the reperfusion therapy of acute myocardial infarction. Heart J, 2006, vol. 27 (16), pp. 1900–1907. DOI: 10.1093/eurheartj/ehl174
4. Rogers W.J., Canto J.G., Lambrew C.T. Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of myocardial infarction 1, 2 and 3. Am. Coll. Cardiol, 2000, vol. 36 (7), pp. 2056–2063.
5. Eagle K.A., Goodman S.G., Avezum A., Budaj A., Sullivan C.M., López-Sendón J. Practice variation and missed opportunities for reperfusion in ST-segment-elevation myocardial infarction: findings from the Global Registry of acute coronary events (GRACE). Lancet, 2002, vol. 359 (9304), pp. 373–377.
6. Benjamin E.J., Muntner P., Alonso A. American Heart Association Council on Epidemiology and Prevention Statistics Committee and Stroke Statistics Subcommittee. Heart Disease and Stroke Statistics-2019 Update: A report from the American Heart Association. Circulation, 2019, vol. 139 (10), pp. e56–e58.
7. Collet J.P., Thiele H., Barbato E. et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Heart J, 2021, vol. 42 (14), pp. 1289–1367. DOI: 10.1093/eurheartj/ehaa575
8. Newby L.K., Rutsch W.R., Califf R.M. et al. Time from symptom onset to treatment and outcomes after thrombolytic therapy. GUSTO-1 Investigators. Am. Coll. Cardiol, 1996, vol. 27 (7), pp. 1646–1655. DOI: 10.1016/0735-1097(96)00053-8
9. Cannon C.P., Gibson C.M., Lambrew C.T. et al. Relationship of symptom-onset-to-balloon time and door-to-balloon time with mortality in patients undergoing angioplasty for acute myocardial infarction. JAMA, 2000, 283 (22), pp. 2941–2947. DOI: 10.1001/jama.283.22.2941
10. Antoniucci D., Valenti R., Migliorini A. et al. Relation of time to treatment and mortality in patients with acute myocardial infarction undergoing primary coronary angioplasty. J. Cardiol, 2002, vol. 89 (11), pp. 1248–1252. DOI: 10.1016/s0002-9149(02)02320-2
11. De Luca G., Suryapranata H., Ottervanger J.P., Antman E.M. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation, 2004, 109 (10), pp. 1223–1225. DOI: 10.1161/01.CIR.0000121424.76486.20
12. Balbaa A., El Guindy A., Pericak D., Natarajan M.K., Schwalm J.D. Before the door: Comparing factors affecting symptom onset to first medical contact for STEMI patients between a high and low-middle income country. J. Cardiol. Heart Vasc, 2022, vol.39, p. 100978. DOI: 10.1016/j.ijcha.2022.100978
13. Jollis J.G., Granger C.B., Zègre-Hemsey J.K. et al. Treatment time and in-hospital mortality among patients with ST-segment elevation myocardial infarction, 2018–2021. JAMA, 2022, vol. 328 (20), pp. 2033–2040. DOI: 10.1001/jama.2022.20149