Impact of total ischemic time on acute heart failure in stemi patients undergoing primary PCI
H G Hayrapetyan, H H Petrosyan, V R Ter-Grigoryan, F I Muradyan, I A Arakelyan, M S Sargsyan, V A Kalantaryan, L H HayrapetyanAbstract
Background
Early reperfusion of the infarct-related coronary artery is crucial for improving long-term outcomes after ST-segment elevation myocardial infarction (STEMI). Several studies have demonstrated the impact of total ischemic time (TIT) on myocardial dysfunction, with prolonged TIT being associated with an increased risk of in-hospital complications.
Purpose
To compare the incidence of moderate (Killip class III) and severe (Killip class IV) acute heart failure (AHF) in STEMI patients according to total ischemic time.
Methods
This study included 351 consecutive STEMI patients undergoing primary percutaneous coronary intervention (PCI). TIT was defined as the time from symptom onset to coronary reperfusion (wire crossing). Patients were divided into two groups: ≤6 hours TIT (Group 1, n=156) and >6 to <12 hours TIT (Group 2, n=195). Baseline clinical and procedural characteristics were comparable between groups. STEMI was diagnosed according to the ESC Universal Definition of Myocardial Infarction. AHF was assessed using the Killip classification. The primary endpoint was the combined incidence of pulmonary oedema (PO) or cardiogenic shock (CS). Secondary endpoints were the individual incidences of PO and CS during hospitalization.
Results
There were no significant differences between groups in the incidence of PO (0.64% [1/156] in Group 1 vs. 2.56% [5/195] in Group 2; p>0.1) or CS (0% [0/156] vs. 1.67% [4/195]; p>0.1). However, the combined endpoint of PO or CS occurred significantly more frequently in Group 2 compared with Group 1 (4.62% [9/195] vs. 0.64% [1/156]; p<0.05).
Conclusion
In STEMI patients undergoing primary PCI, a total ischemic time exceeding 6 hours is associated with a significantly higher incidence of in-hospital acute heart failure, defined as pulmonary oedema or cardiogenic shock, compared with patients reperfused within 6 hours.