Time-to-treatment and infarct size in STEMI patients undergoing primary angioplasty

Background: Several reports have shown that in patient with ST-segment elevation acute myocardial infarction (STEMI) longer ischemia time is associated with impaired reperfusion and higher mortality. However, there is still some doubts with regards time to reperfusion role in patients treated with primary percutaneous coronary intervention (PCI). Therefore, the aim of the current study was to evaluate the impact of time-to-treatment on infarct size as evaluated by myocardial scintigraphy in a large cohort of STEMI patients undergoing primary PCI. Methods: Our population is represented by 830 STEMI patients undergoing primary PCI. Infarct size was evaluated at 30 days by technetium-99m-sestamibi. Results: Time-to-treatment was significantly associated with age and dyslipidemia. Time-to-treatment linearly affected the rate of postprocedural TIMI 3 flow (p < 0.0001) and scintigraphic infarct size (p < 0.001). The impact of time-to-treatment on infarct size persisted in the analysis restricted to patients with postpocedural TIMI 3 flow, and after correction for confounding factors such as age, dyslipidemia, postprocedural TIMI 3 flow (OR [95% CI] = 1.26 [1.14-1.39], p < 0.001). Conclusions: This study shows in a large population of STEMI patients undergoing primary PCI that time-to-treatment is linearly associated with infarct size.