IMPACT OF TOTAL ISCHEMIC TIME ON THE RECOVERY OF REGIONAL WALL MOTION ABNORMALITY AFTER STEMI IN PATIENTS UNDERGOING PCI

Authors

  • MI SHINWARI Department of Health, District Jail Hangu., KPK, Pakistan
  • FU KHAN Department of Cardiology, Hayatabad Medical Complex Peshawar, Pakistan
  • AA KHAN Department of Cardiology, Hayatabad Medical Complex Peshawar, Pakistan
  • S AMIN Department of Internal Medicine, Ayub Teaching Hospital Abbottabad, Pakistan
  • MA ALI Department of Internal Medicine, Ayub Teaching Hospital Abbottabad, Pakistan
  • U SIDDIQE Department of Internal Medicine, Ayub Teaching Hospital Abbottabad, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2023i1.275

Keywords:

Reperfusion, Clinical Outcomes,, Odds Ratio, WMSI, STEMI, PCI, RWMA, TIT

Abstract

This study was designed to evaluate the impact of total ischemic time (TIT) on the recovery of regional wall motion abnormality (RWMA) in patients undergoing percutaneous coronary intervention (PCI) after ST-elevation myocardial infarction (STEMI). This was a single-center retrospective study of 155 patients with STEMI who underwent PCI at the Medical Teaching Institute-Hayatabad Medical Complex in Peshawar from May 3, 2022, to October 5, 2022. The primary outcome was the recovery of RWMA, as assessed by the wall motion score index (WMSI) at discharge. Longer TIT was associated with a decreased likelihood of recovery of RWMA (adjusted odds ratio [OR], 0.72; 95% confidence interval [CI], 0.59-0.89; P=0.002). Patients with TITs of 180 minutes or less were more likely to experience a decrease in WMSI (OR, 3.02; 95% CI, 1.36-6.71; P=0.007) if they were older, had an anterior myocardial infarction, and had higher baseline WMSI. Our study demonstrates that longer TIT is associated with a reduced likelihood of recovery of RWMA after STEMI in patients undergoing PCI. Timely reperfusion is crucial for improving myocardial function and optimizing clinical outcomes in these patients. Strategies to minimize TITs, such as pre-hospital activation of the catheterization laboratory, streamlined processes for door-to-balloon time, and advanced imaging techniques to guide revascularization, may improve outcomes in this patient population.

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References

De Luca G, Suryapranata H, Zijlstra F, van 't Hof AW, Hoorntje JC, Gosselink AT, et al. Symptom-onset-to-balloon time and mortality in patients with acute myocardial infarction treated by primary angioplasty. J Am Coll Cardiol. 2003;42(6):991-997.

Nallamothu BK, Bates ER, Herrin J, Wang Y, Bradley EH, Krumholz HM. Times to treatment in transfer patients undergoing primary percutaneous coronary intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 analysis. Circulation. 2005;111(6):761-767.

Gersh BJ, Stone GW, White HD, Holmes DR Jr. Pharmacological facilitation of primary percutaneous coronary intervention for acute myocardial infarction: is the slope of the curve the shape of the future? JAMA. 2005;293(8):979-986.

O'Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):e78-e140.

Jneid H, Anderson JL, Wright RS, Adams CD, Bridges CR, Casey DE Jr, et al. 2012 ACCF/AHA focused update of the guideline for the management of patients with unstable angina/non-ST-elevation myocardial infarction (updating the 2007 guideline and replacing the 2011 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2012;60(7):645-681.

Seo JH, Kim KH, Chun KJ, Lee BK, Cho BR, Ryu DR. Impact of Total Ischemic Time on the Recovery of Regional Wall Motion Abnormality after STEMI in the Modern Reperfusion Era. J Interv Cardiol. 2022 Jan 22;2022:2447707. doi: 10.1155/2022/2447707. PMID: 35136385; PMCID: PMC8800598.

Ahn K. T., Song Y. B., Choe Y. H., et al. Impact of transmural necrosis on left ventricular remodeling and clinical outcomes in patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction. The International Journal of Cardiovascular Imaging . 2013;29(4):835–842. doi: 10.1007/s10554-012-0155-9.

Wickline S. A., Verdonk E. D., Wong A. K., Shepard R. K., Miller J. G. Structural remodeling of human myocardial tissue after infarction. Quantification with ultrasonic backscatter. Circulation . 1992;85(1):259–268. doi: 10.1161/01.cir.85.1.259

Members A. T. F., Steg P. G., James S. K. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC) European Heart Journal . 2012;33(20):2569–2619

Lubovich A., Dobrecky-mery I., Radzishevski E., et al. Bypassing the emergency room to reduce door-to-balloon time and improve outcomes of ST elevation myocardial infarction patients: analysis of data from 2004-2010 ACSIS registry. Journal of Interventional Cardiology . 2015;28(2):141–146. doi: 10.1111/joic.12192.

Tarantini G., Cacciavillani L., Corbetti F., et al. Duration of ischemia is a major determinant of transmurality and severe microvascular obstruction after primary angioplasty. Journal of the American College of Cardiology . 2005;46(7):1229–1235. doi: 10.1016/j.jacc.2005.06.054.

Witt N., Samad B. A., Frick M., Alam M., imaging f. Detection of left ventricular dysfunction by Doppler tissue imaging in patients with complete recovery of visual wall motion abnormalities 6 months after a first ST-elevation myocardial infarction. Clinical Physiology and Functional Imaging . 2007;27(5):305–308. doi: 10.1111/j.1475-097x.2007.00752.x.

Reimer K. A., Lowe J. E., Rasmussen M. M., Jennings R. B. The wavefront phenomenon of ischemic cell death. 1. Myocardial infarct size vs. duration of coronary occlusion in dogs. Circulation . 1977;56(5):786–794. doi: 10.1161/01.cir.56.5.786

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Published

2023-05-14

How to Cite

SHINWARI, M., KHAN , F., KHAN, A., AMIN, S., ALI, M., & SIDDIQE, U. (2023). IMPACT OF TOTAL ISCHEMIC TIME ON THE RECOVERY OF REGIONAL WALL MOTION ABNORMALITY AFTER STEMI IN PATIENTS UNDERGOING PCI. Biological and Clinical Sciences Research Journal, 2023(1), 275. https://doi.org/10.54112/bcsrj.v2023i1.275

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