Home > Uncategorized > Journal Club 22 April 2015

Journal Club 22 April 2015

Paper

The influence of system delay on 30-day and on long-term mortality in patients with anterior versus non-anterior ST-segment elevation myocardial infarction: a cohort study

Presenter

AB

Summary

Aim:

To evaluate the relationship between system delay and 30-day and long-term mortality in patients
with anterior versus non-anterior ST-elevation
myocardial infarction (STEMI).

Methods:

We conducted a prospective observational
cohort study. Patients with STEMI who were
transported to the Isala Hospital, Zwolle, and
underwent primary percutaneous coronary intervention
(pPCI) from 2005 until 2010 were included. These
patients were divided into quartiles of system delay
(time from first medical contact until reperfusion
therapy): Q1–Q4.

Results:

In total, 3041 patients were included in our
study. 41% (n=1253) of the patients had an anterior
myocardial infarction (MI) and 59% of the patients
(n=1788) had a non-anterior MI. Only in patients with
an anterior MI, prolonged system delay was associated
with a higher mortality (30-day Q1: 2.6%, Q2: 3.1%,
Q3: 6.8%, Q4: 7.4%, p=0.001; long-term Q1: 12.8%,
Q2: 13.7%, Q3: 24.1%, Q4: 22.6%, p<0.001). After
multivariable adjustment, prolonged system delay was
associated with a higher 30-day and long-term mortality
in patients with an anterior MI (30 day Q2: HR 1.18,
95% CI (0.46 to 3.00), Q3: HR 2.45, 95% CI (1.07 to
5.63), Q4: HR 2.25, 95% CI (0.97 to 5.25)); long-term
Q2: HR 1.09, 95% CI (0.71 to 1.68), Q3: HR 1.68, 95%
CI (1.13 to 2.49), Q4: HR 1.55, 95% CI (1.03 to 2.33)),
but not in patients with a non-anterior MI.

Conclusions:

Prolonged system delay significantly
increased short-term as well as long-term mortality in
patients with an anterior MI. This effect was not
demonstrated in patients with a non-anterior MI.
Therefore, it is of the greatest importance to minimise
system delay in patients who present with an anterior MI.

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