Impact of Total Ischemic Time on Clinical Outcome in Stemi Patients Undergoing Percutaneous Coronary Intervention

Abstract

Background: ST-segment elevation myocardial infarction (STEMI) represents a critical condition requiring prompt treatment to minimize myocardial damage. Percutaneous coronary intervention (PCI) is the preferred reperfusion strategy, with the total ischemic time (TIT) being a crucial determinant of clinical outcomes. Despite the recognized importance of minimizing door-to-balloon (DTB) time, the impact of TIT on STEMI outcomes necessitates further exploration. Objective: This study aimed to evaluate the association between TIT and clinical outcomes in STEMI patients undergoing PCI, specifically focusing on all-cause mortality, re-hospitalization, and revascularization rates. Methods: A descriptive study was conducted at the cardiology ward of Lady Reading Hospital from May 2023 to October 2023. Ninety patients diagnosed with STEMI and undergoing PCI were enrolled. Patients were excluded if they had a history of cardiac surgeries or a DTB time >90 minutes. TIT was categorized into ≤120 minutes (Group A) and >120 minutes (Group B). Clinical outcomes assessed at 6 months post-PCI included all-cause mortality, cardiac mortality, re-hospitalization, and revascularization. Data were analyzed using SPSS version 25, employing Chi-Square tests for categorical variables, with a p-value ≤ 0.05 considered statistically significant. Results: Among the participants, Group A (TIT ≤ 120 mins) comprised 33 patients, while Group B (TIT > 120 mins) included 57 patients. Increased TIT was associated with higher rates of all-cause mortality (21.1% in Group B vs. 6.1% in Group A, p=0.05), re-hospitalization (22.8% vs. 6.1%, p=0.04), and revascularization (29.8% vs. 12.1%, p=0.05). Cardiac mortality was also higher in Group B (10.5%) compared to Group A (3.0%), though this difference was not statistically significant (p=0.20). Conclusion: The study highlights the significant impact of TIT on the prognosis of STEMI patients undergoing PCI. Shorter TIT is associated with markedly better clinical outcomes, emphasizing the need for healthcare systems to adopt strategies that reduce both pre-hospital and in-hospital delays.