In the Journals

Shorter reperfusion time decreases in-hospital HF after primary PCI

Recent study results have linked reduced time to reperfusion to a decrease in post-admission in-hospital HF in patients with STEMI undergoing primary PCI.

Using data from the Singapore Myocardial Infarct Registry, the researchers evaluated the relationship between time from first medical contact to deployment of first device to achieve reperfusion and in-hospital HF events, HF rehospitalizations and mortality in 7,597 patients undergoing PCI from 2007 to 2013.

At the population level, the median time to reperfusion decreased from 91 minutes in 2007 to 58 minutes in 2013 (P = .001). However, there was no change in-hospital mortality (P = .19) and 1-year all-cause mortality (P = .505) over time.

Notably, the incidence of HF at admission increased from 12.2% in 2007 to 18.4% in 2013 (P = .02), according to the researchers. Additionally, among the patients presenting to the ED with HF, the proportion of those in Killip class III or IV also increased (P < .001).

Despite this increase in patients with HF at admission, the annual incidence of post-admission in-hospital HF declined from 12.8% in 2007 to 7.1% in 2013 (P = .03). Furthermore, there was an increase from 7.1% in 2007 to 14.8% in 2013 in the proportion of patients whose Killip class improved during the index hospitalization (P = .008). In contrast, there was a decrease from 8.9% to 3.6% in the proportion of patients whose Killip class worsened during the index hospitalization during the study period (P = .041).

The researchers noted, however, that 30-day rehospitalization for HF increased from 1.2% to 2.6% (P = .003) and 1-year rehospitalization for HF increased from 3.8% to 5.6% from 2007 to 2013 (P = .037).

At the individual patient level, longer times to reperfusion were significantly associated with greater in-hospital, 30-day and 1-year mortality before and after adjustment for potential confounders. Longer reperfusion times were also linked to greater incidence of post-admission in-hospital HF and 30-day and 1-year rehospitalization for HF in univariable analyses. However, although the relationship between reperfusion time and in-hospital HF remained significant in multivariable analyses, the association was weaker for 30-day and 1-year rehospitalization for HF.

In the subgroup of patients with HF at admission, the risk for 30-day rehospitalization for HF was nearly three times higher for patients with reperfusion times greater than 90 minutes vs. those with reperfusion times less than 60 minutes. Furthermore, the risk for 1-year rehospitalization for HF was nearly twice as high for patients with reperfusion times greater than 120 minutes vs. less than 60 minutes.

The lack of change in mortality despite improved reperfusion times should be interpreted in the context of the increase in patients with severe acute HF undergoing PCI, especially because mortality benefits are demonstrated at the individual patient level, according to the researchers.

These data, they concluded, underscore the importance of monitoring reperfusion time as a quality metric of STEMI care. – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.

Recent study results have linked reduced time to reperfusion to a decrease in post-admission in-hospital HF in patients with STEMI undergoing primary PCI.

Using data from the Singapore Myocardial Infarct Registry, the researchers evaluated the relationship between time from first medical contact to deployment of first device to achieve reperfusion and in-hospital HF events, HF rehospitalizations and mortality in 7,597 patients undergoing PCI from 2007 to 2013.

At the population level, the median time to reperfusion decreased from 91 minutes in 2007 to 58 minutes in 2013 (P = .001). However, there was no change in-hospital mortality (P = .19) and 1-year all-cause mortality (P = .505) over time.

Notably, the incidence of HF at admission increased from 12.2% in 2007 to 18.4% in 2013 (P = .02), according to the researchers. Additionally, among the patients presenting to the ED with HF, the proportion of those in Killip class III or IV also increased (P < .001).

Despite this increase in patients with HF at admission, the annual incidence of post-admission in-hospital HF declined from 12.8% in 2007 to 7.1% in 2013 (P = .03). Furthermore, there was an increase from 7.1% in 2007 to 14.8% in 2013 in the proportion of patients whose Killip class improved during the index hospitalization (P = .008). In contrast, there was a decrease from 8.9% to 3.6% in the proportion of patients whose Killip class worsened during the index hospitalization during the study period (P = .041).

The researchers noted, however, that 30-day rehospitalization for HF increased from 1.2% to 2.6% (P = .003) and 1-year rehospitalization for HF increased from 3.8% to 5.6% from 2007 to 2013 (P = .037).

At the individual patient level, longer times to reperfusion were significantly associated with greater in-hospital, 30-day and 1-year mortality before and after adjustment for potential confounders. Longer reperfusion times were also linked to greater incidence of post-admission in-hospital HF and 30-day and 1-year rehospitalization for HF in univariable analyses. However, although the relationship between reperfusion time and in-hospital HF remained significant in multivariable analyses, the association was weaker for 30-day and 1-year rehospitalization for HF.

In the subgroup of patients with HF at admission, the risk for 30-day rehospitalization for HF was nearly three times higher for patients with reperfusion times greater than 90 minutes vs. those with reperfusion times less than 60 minutes. Furthermore, the risk for 1-year rehospitalization for HF was nearly twice as high for patients with reperfusion times greater than 120 minutes vs. less than 60 minutes.

The lack of change in mortality despite improved reperfusion times should be interpreted in the context of the increase in patients with severe acute HF undergoing PCI, especially because mortality benefits are demonstrated at the individual patient level, according to the researchers.

These data, they concluded, underscore the importance of monitoring reperfusion time as a quality metric of STEMI care. – by Melissa Foster

Disclosures: The authors report no relevant financial disclosures.