Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction

Jacob Lønborg; Mikkel Malby Schoos; Henning Kelbæk; Lene Holmvang; Jacob Steinmetz; Niels Vejlstrup; Erik Jørgensen; Steffen Helqvist; Kari Saunamäki; Hans Erik Bøtker; Won Yong Kim; Christian Juhl Terkelsen; Peter Clemmensen; Thomas Engstrøm

doi:10.1016/j.ahj.2012.07.021

Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction

Jacob Lønborg, Mikkel Malby Schoos, Henning Kelbæk, Lene Holmvang, Jacob Steinmetz, Niels Vejlstrup, Erik Jørgensen, Steffen Helqvist, Kari Saunamäki, Hans Erik Bøtker, Won Yong Kim, Christian Juhl Terkelsen, Peter Clemmensen, Thomas Engstrøm

38 Citations (Scopus)

Abstract

Background: The association between reperfusion delay and myocardial damage has previously been assessed by evaluation of the duration from symptom onset to invasive treatment, but results have been conflicting. System delay defined as the duration from first medical contact to first balloon dilatation is less prone to bias and is also modifiable. The purpose was to evaluate the impact of system delay on myocardial salvage index (MSI) and infarct size in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI). Methods: In patients with ST-elevation myocardial infarction, MSI and final infarct size were assessed using cardiovascular magnetic resonance. Myocardial area at risk was measured within 1 to 7 days, and final infarct size was measured 90 ± 21 days after intervention. Patients were grouped according to system delay (0 to 120, 121 to 180, and >180 minutes). Results: In 219 patients, shorter system delay was associated with a smaller infarct size (8% [interquartile range 4-12%], 10% [6-16%], and 13% [8-17%]; P <.001) and larger MSI (0.77 [interquartile range 0.66-0.86], 0.72 [0.59-0.80], and 0.68 [0.64-0.72]; P =.005) for a system delay of up to 120, 121 to 180, and >180 minutes, respectively. A short system delay as a continuous variable independently predicted a smaller infarct size (r = 0.30, P <.001) and larger MSI (r = -0.25, P <.001) in multivariable linear regression analyses. Finally, shorter system delay (0-120 minutes) was associated with improved function (P =.019) and volumes of left ventricle (P =.022). Conclusions: A shorter system delay resulted in smaller infarct size, larger MSI, and improved LV function in patients treated with primary PCI. Thus, this study confirms that minimizing system delay is crucial for primary PCI-related benefits.

Original language	English
Journal	American Heart Journal
Volume	164
Issue number	4
Pages (from-to)	538-46
Number of pages	9
ISSN	0002-8703
DOIs	https://doi.org/10.1016/j.ahj.2012.07.021
Publication status	Published - Oct 2012

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10.1016/j.ahj.2012.07.021

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Lønborg, J., Schoos, M. M., Kelbæk, H., Holmvang, L., Steinmetz, J., Vejlstrup, N., Jørgensen, E., Helqvist, S., Saunamäki, K., Bøtker, H. E., Kim, W. Y., Terkelsen, C. J., Clemmensen, P., & Engstrøm, T. (2012). Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction. American Heart Journal, 164(4), 538-46. https://doi.org/10.1016/j.ahj.2012.07.021

Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction. / Lønborg, Jacob; Schoos, Mikkel Malby; Kelbæk, Henning et al.

In: American Heart Journal, Vol. 164, No. 4, 10.2012, p. 538-46.

Research output: Contribution to journal › Journal article › Research › peer-review

Lønborg, J, Schoos, MM, Kelbæk, H, Holmvang, L, Steinmetz, J, Vejlstrup, N, Jørgensen, E, Helqvist, S, Saunamäki, K, Bøtker, HE, Kim, WY, Terkelsen, CJ, Clemmensen, P & Engstrøm, T 2012, 'Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction', American Heart Journal, vol. 164, no. 4, pp. 538-46. https://doi.org/10.1016/j.ahj.2012.07.021

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title = "Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction",

abstract = "Background: The association between reperfusion delay and myocardial damage has previously been assessed by evaluation of the duration from symptom onset to invasive treatment, but results have been conflicting. System delay defined as the duration from first medical contact to first balloon dilatation is less prone to bias and is also modifiable. The purpose was to evaluate the impact of system delay on myocardial salvage index (MSI) and infarct size in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI). Methods: In patients with ST-elevation myocardial infarction, MSI and final infarct size were assessed using cardiovascular magnetic resonance. Myocardial area at risk was measured within 1 to 7 days, and final infarct size was measured 90 ± 21 days after intervention. Patients were grouped according to system delay (0 to 120, 121 to 180, and >180 minutes). Results: In 219 patients, shorter system delay was associated with a smaller infarct size (8% [interquartile range 4-12%], 10% [6-16%], and 13% [8-17%]; P <.001) and larger MSI (0.77 [interquartile range 0.66-0.86], 0.72 [0.59-0.80], and 0.68 [0.64-0.72]; P =.005) for a system delay of up to 120, 121 to 180, and >180 minutes, respectively. A short system delay as a continuous variable independently predicted a smaller infarct size (r = 0.30, P <.001) and larger MSI (r = -0.25, P <.001) in multivariable linear regression analyses. Finally, shorter system delay (0-120 minutes) was associated with improved function (P =.019) and volumes of left ventricle (P =.022). Conclusions: A shorter system delay resulted in smaller infarct size, larger MSI, and improved LV function in patients treated with primary PCI. Thus, this study confirms that minimizing system delay is crucial for primary PCI-related benefits.",

author = "Jacob L{\o}nborg and Schoos, {Mikkel Malby} and Henning Kelb{\ae}k and Lene Holmvang and Jacob Steinmetz and Niels Vejlstrup and Erik J{\o}rgensen and Steffen Helqvist and Kari Saunam{\"a}ki and B{\o}tker, {Hans Erik} and Kim, {Won Yong} and Terkelsen, {Christian Juhl} and Peter Clemmensen and Thomas Engstr{\o}m",

year = "2012",

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doi = "10.1016/j.ahj.2012.07.021",

language = "English",

volume = "164",

pages = "538--46",

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issn = "0002-8703",

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T1 - Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction

AU - Lønborg, Jacob

AU - Schoos, Mikkel Malby

AU - Kelbæk, Henning

AU - Holmvang, Lene

AU - Steinmetz, Jacob

AU - Vejlstrup, Niels

AU - Jørgensen, Erik

AU - Helqvist, Steffen

AU - Saunamäki, Kari

AU - Bøtker, Hans Erik

AU - Kim, Won Yong

AU - Terkelsen, Christian Juhl

AU - Clemmensen, Peter

AU - Engstrøm, Thomas

PY - 2012/10

Y1 - 2012/10

N2 - Background: The association between reperfusion delay and myocardial damage has previously been assessed by evaluation of the duration from symptom onset to invasive treatment, but results have been conflicting. System delay defined as the duration from first medical contact to first balloon dilatation is less prone to bias and is also modifiable. The purpose was to evaluate the impact of system delay on myocardial salvage index (MSI) and infarct size in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI). Methods: In patients with ST-elevation myocardial infarction, MSI and final infarct size were assessed using cardiovascular magnetic resonance. Myocardial area at risk was measured within 1 to 7 days, and final infarct size was measured 90 ± 21 days after intervention. Patients were grouped according to system delay (0 to 120, 121 to 180, and >180 minutes). Results: In 219 patients, shorter system delay was associated with a smaller infarct size (8% [interquartile range 4-12%], 10% [6-16%], and 13% [8-17%]; P <.001) and larger MSI (0.77 [interquartile range 0.66-0.86], 0.72 [0.59-0.80], and 0.68 [0.64-0.72]; P =.005) for a system delay of up to 120, 121 to 180, and >180 minutes, respectively. A short system delay as a continuous variable independently predicted a smaller infarct size (r = 0.30, P <.001) and larger MSI (r = -0.25, P <.001) in multivariable linear regression analyses. Finally, shorter system delay (0-120 minutes) was associated with improved function (P =.019) and volumes of left ventricle (P =.022). Conclusions: A shorter system delay resulted in smaller infarct size, larger MSI, and improved LV function in patients treated with primary PCI. Thus, this study confirms that minimizing system delay is crucial for primary PCI-related benefits.

AB - Background: The association between reperfusion delay and myocardial damage has previously been assessed by evaluation of the duration from symptom onset to invasive treatment, but results have been conflicting. System delay defined as the duration from first medical contact to first balloon dilatation is less prone to bias and is also modifiable. The purpose was to evaluate the impact of system delay on myocardial salvage index (MSI) and infarct size in patients with ST-elevation myocardial infarction treated with primary percutaneous coronary intervention (PCI). Methods: In patients with ST-elevation myocardial infarction, MSI and final infarct size were assessed using cardiovascular magnetic resonance. Myocardial area at risk was measured within 1 to 7 days, and final infarct size was measured 90 ± 21 days after intervention. Patients were grouped according to system delay (0 to 120, 121 to 180, and >180 minutes). Results: In 219 patients, shorter system delay was associated with a smaller infarct size (8% [interquartile range 4-12%], 10% [6-16%], and 13% [8-17%]; P <.001) and larger MSI (0.77 [interquartile range 0.66-0.86], 0.72 [0.59-0.80], and 0.68 [0.64-0.72]; P =.005) for a system delay of up to 120, 121 to 180, and >180 minutes, respectively. A short system delay as a continuous variable independently predicted a smaller infarct size (r = 0.30, P <.001) and larger MSI (r = -0.25, P <.001) in multivariable linear regression analyses. Finally, shorter system delay (0-120 minutes) was associated with improved function (P =.019) and volumes of left ventricle (P =.022). Conclusions: A shorter system delay resulted in smaller infarct size, larger MSI, and improved LV function in patients treated with primary PCI. Thus, this study confirms that minimizing system delay is crucial for primary PCI-related benefits.

U2 - 10.1016/j.ahj.2012.07.021

DO - 10.1016/j.ahj.2012.07.021

M3 - Journal article

C2 - 23067912

SN - 0002-8703

VL - 164

SP - 538

EP - 546

JO - American Heart Journal

JF - American Heart Journal

IS - 4

ER -

Impact of system delay on infarct size, myocardial salvage index, and left ventricular function in patients with ST-segment elevation myocardial infarction

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