Abstract
Background Total ischemic time (TIT) is an important factor for predicting mortality among patients with ST-segment elevation myocardial infarction (STEMI). However, the correlation between TIT and the extent of wall motion abnormality has not been well studied. Therefore, we investigated changes in the wall motion score index (WMSI) value based on TIT in STEMI patients who underwent primary percutaneous coronary intervention (PCI) and subsequent transthoracic echocardiography. Methods STEMI patients who underwent primary PCI and follow-up coronary angiography were analyzed after the exclusion of cases of in-stent restenosis (ISR). WMSI values were calculated by dividing the sum of scores by the number of segments visualized. Results A total of 189 patients underwent primary PCI for STEMI, and 151 had no ISR with a median follow-up of 12.3 months. TIT was 180 (117–369) minutes in a subset of 151 patients (mean age of 62 years; 76% male). Among patients without ISR, 109 (72%) demonstrated a decrease in the WMSI value during the follow-up period. The WMSI values of patients with TITs of 180 minutes or less were significantly decreased relative to those among patients with TITs of greater than 180 minutes (p=0.020). Among patients with TITs of 180 minutes or less, the TIT was significantly shorter among those with a reduction in the WMSI value than among those with an increase in the WMSI value (106 [81–124] vs. 133 [100–151] minutes; p=0.018). TIT was an independent predictor for a reduction in the WMSI value among these patients (adjusted hazard ratio: 0.976 (0.957–0.995); p=0.016). Conclusions In the modern reperfusion era of STEMI, patients with TITs of 180 minutes or less experienced a significant degree of recovery from regional wall motion abnormalities.
Highlights
Primary percutaneous coronary intervention (PCI) is the current preferred strategy to treat ST-segment elevation myocardial infarction (STEMI) [1]. e maximum myocardial salvage gained from reperfusion therapy is generally accepted to occur within the first few hours of symptom onset, and the potential for salvaging myocardium is considered minimal or absent after this time. [2, 3]
A total of 151 patients were analyzed in this study (Figure 1) and were stratified as those with a decrease and those with an increase in the wall motion score index (WMSI) value during the follow-up period. is study was approved by the Kangwon National University Hospital Institutional Ethics Committee/Review Board (Study no. 2018-12-004)
Baseline characteristics of the patients according to changes in WMSI value are summarized in Table 1. ere were no significant differences in terms of age, sex, comorbidities, STEMI location, or medication use between patients who experienced a decrease in WMSI value and those who showed an increase in the WMSI value. e total door-to-balloon time and Total ischemic time (TIT) were statistically indifferent between the two groups
Summary
Primary percutaneous coronary intervention (PCI) is the current preferred strategy to treat ST-segment elevation myocardial infarction (STEMI) [1]. e maximum myocardial salvage gained from reperfusion therapy is generally accepted to occur within the first few hours of symptom onset, and the potential for salvaging myocardium is considered minimal or absent after this time. [2, 3]. Primary percutaneous coronary intervention (PCI) is the current preferred strategy to treat ST-segment elevation myocardial infarction (STEMI) [1]. Total ischemic time (TIT) is an important factor for predicting mortality among patients with ST-segment elevation myocardial infarction (STEMI). The correlation between TIT and the extent of wall motion abnormality has not been well studied. Erefore, we investigated changes in the wall motion score index (WMSI) value based on TIT in STEMI patients who underwent primary percutaneous coronary intervention (PCI) and subsequent transthoracic echocardiography. A total of 189 patients underwent primary PCI for STEMI, and 151 had no ISR with a median follow-up of 12.3 months. In the modern reperfusion era of STEMI, patients with TITs of 180 minutes or less experienced a significant degree of recovery from regional wall motion abnormalities
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