Abstract 11928: An Interaction Between The Time Delay And Pharmacologic Pre-treatment. Effect On Myocardial Perfusion And Infarct Size
Introduction: Primary percutaneous coronary intervention (PCI) is the preferred method of reperfusion in STEMI patients. However, optimal adjunctive pharmacotherapy is still under investigation.
Hypothesis: To assess the effect of triple pharmacologic therapy on myocardial perfusion and infarct size in relation to different time delays.
Methods: We studied 309 consecutive STEMI patients admitted within 12 hours from symptom onset with: (1) chest pain persisting for >30min, (2) ST-segment elevation >1mm in ≥ 2 contiguous leads, (4) pre-treatment with 600mg of clopidogrel, 300mg of aspirin and 5000U of intravenous heparin. Group I (n=90) comprised patients transferred immediately to cathlab, group II (n=219) consisted of patients transferred via local hospitals (staged transfer). Results of TIMI flow prior to PCI and post-PCI, ST-segment resolution, troponin T level and MBG were analyzed in relation to time delay to intervention.
Results: The median time interval between the onset of symptoms and pharmacologic pre-treatment was comparable in both groups, but the delay between pharmacologic pre-treatment and angiography was twice longer in cases of staged transfer. Despite a longer delay to intervention, higher rates of pre-angiography total ST-segment resolution (STSR) and TIMI flow 3 at initial angiography were observed in those patients. Differences in the rate of total STSR, TIMI flow 3 and MBG were no longer observed post PCI. Similarly, the peak troponin level was comparable in both groups - table.
Conclusions: 1. Pre-hospital treatment with a combination of antiplatelet and antithrombotic agents improves myocardial perfusion.
2. Longer transfer delay paradoxically allows for the amplification of pharmacologic pre-treatment before mechanical reperfusion.
Author Disclosures: M. Prech: None. E. Bartela: None. M. Janus: None. A. Araszkiewicz: None. I. Jeremicz: None. A. Kutrowska: None. M. Pyda: None.
- © 2015 by American Heart Association, Inc.