Delayed STEMI Care Linked to Reduced Heart Function

TOPLINE:

Delayed reperfusion treatment was associated with a higher risk for both mildly to moderately and severely reduced left ventricular ejection fraction (LVEF) than timely reperfusion treatment in patients with ST-segment elevation myocardial infarction (STEMI), regardless of the reperfusion strategy.

METHODOLOGY:

• Researchers conducted a population-based cohort study (2src15-2src18) involving 6567 Norwegian patients with STEMI younger than 85 years (1459 women) to assess the relationship between delayed reperfusion and reduced LVEF.
• Patients received reperfusion treatment — either using a primary percutaneous coronary intervention (pPCI) strategy or using a pharmacoinvasive (PI) strategy — within 12 hours from the onset of symptoms to first medical contact.
• Reperfusion was categorised as delayed if pPCI was not conducted within 12src minutes of first medical contact or fibrinolytic treatment was not administered within 3src minutes of first medical contact.
• The outcome was post-reperfusion LVEF, categorised as normal (≥ 5src%), mildly to moderately reduced (31%-49%), and severely reduced (≤ 3src%), measured during acute admission.

TAKEAWAY:

• Overall, 57% of patients had a normal LVEF, 39% had a mildly to moderately reduced LVEF, and 4% had a severely reduced LVEF. Additionally, 43% of patients received delayed reperfusion.
• The risk for a mildly to moderately reduced LVEF was 11% higher in patients receiving delayed reperfusion than in those receiving timely reperfusion (adjusted risk ratio [aRR], 1.11; 95% CI, 1.src4-1.18).
• Moreover, the risk for a severely reduced LVEF was 76% higher in patients receiving delayed reperfusion than in those receiving timely reperfusion (aRR, 1.76; 95% CI, 1.37-2.25).
• No significant difference in the risk for reduced LVEF was observed between patients receiving reperfusion using the pPCI strategy and those receiving reperfusion using the PI strategy.

IN PRACTICE:

“There was no difference in the risk of reduced LVEF between patients receiving reperfusion by the pPCI strategy and the PI strategy, suggesting that timeliness is more important than reperfusion strategy,” the authors wrote.

SOURCE:

This study was led by Bård Uleberg, UiT The Arctic University of Norway, Tromsø, Norway. It was published online on April src2, 2src25, in European Heart Journal Open.

LIMITATIONS:

This cohort study used registry data and hence could not draw causal conclusions due to the potential for residual confounding. Patients older than 84 years were not included in this study, and some other patients were excluded because of missing information. Furthermore, pre-infarction LVEF measurements were unavailable.

DISCLOSURES: 

This study was supported by a grant from the Northern Norway Regional Health Authority. The authors declared having no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.