Abstract 11167: Association of Time to Reperfusion with Left Ventricular Function and Heart Failure in Acute Myocardial Infarction Patients treated with Primary Percutaneous Coronary Intervention - A Systematic review
Background: Shorter time to reperfusion is associated with a significant reduction in mortality, however its association with incident heart failure (HF) is not clearly documented. We conducted a systematic review to examine the association between time to reperfusion and incident HF and/or left ventricular dysfunction.
Methods: MEDLINE/OVID, EMBASE, Cochrane library and Web of Science databases were searched from January 1974 to May 2012 for studies that reported the association between time to reperfusion and incident HF or left ventricular ejection fraction (LVEF) in patients undergoing primary PCI.
Results: Out of 362 non-duplicate abstracts, 71 studies were selected for full-text review. Thirty-four studies were included in the final systematic review, out of which 17 were single-center studies, 8 were population-based studies, 7 were sub-analyses from randomized-controlled trials and 2 were based on national samples. The pooled data demonstrates that every 1-hour delay in time to reperfusion is associated with a 4%-12% increased risk of new-onset HF and a 2% increased risk of diastolic dysfunction at time of index admission and a 4% relative increase in the risk of incident HF during follow-up. Early reperfusion was associated with a 2%-8% greater LVEF before discharge and a 3%-12% larger improvement in absolute LVEF at follow-up as compared to the index admission.
Conclusions: This systematic review presents evidence that longer time to reperfusion is not only associated with worsened left ventricular systolic and diastolic function, and new-onset heart failure at the time of index admission, but also with reduced improvement in left ventricular systolic function during follow-up.
- © 2012 by American Heart Association, Inc.