RESUMEN
AIMS: The impact of reperfusion delay in ST-elevation myocardial infarction (STEMI) is well known. We aimed to describe the specific reasons for delay to primary percutaneous coronary intervention (pPCI), and their impact on mortality after adjusting for confounders, using the first-medical-contact-to-device (FMCTD) time to measure the delay. METHODS: Between January 2006 and December 2019, 2149 STEMI patients underwent pPCI at our centre. Delayed pPCI was defined as FMCTDâ>â90âmin orâ>â120âmin in the case of inter-hospital transfer. The causes of delay were classified as system-related (related to the network organization) or patient-related (related to the clinical condition of the patient). Primary outcome was 1-year all-cause mortality. RESULTS: The pPCI was timely in 69.9% of patients, delayed for system-related causes in 16.4% or for patient-related causes in 13.7%. Different patient-related causes induced variable median FMCTD time (from 114 min for technically difficult pPCI to 159 min for ECG and/or symptom resolution). By multivariable Cox-regression models, the main independent risk factors for mortality were delay due to comorbidities [hazard ratio (HR) 2.19 (1.22-3.91)], or hemodynamic instability [HR 2.05 (1.25-3.38)], after adjusting for Global Registry of Acute Coronary Events risk score tertiles and angiographic success. The difference in risk of mortality is maintained over the entire spectrum of time from symptom onset. CONCLUSIONS: Different causes of delay had different impacts on mortality, generally more important than the length of the delay. Causes of delay such as hemodynamic instability and comorbidities should prompt specific programs of performance improvement. Timely pPCI maintains prognostic advantages after several hours from symptom onset, mandating prompt reperfusion also in late-presenter patients.
Asunto(s)
Reperfusión Miocárdica/métodos , Intervención Coronaria Percutánea , Sistema de Registros , Infarto del Miocardio con Elevación del ST/cirugía , Tiempo de Tratamiento , Anciano , Causas de Muerte/tendencias , Femenino , Estudios de Seguimiento , Humanos , Italia/epidemiología , Masculino , Pronóstico , Estudios Prospectivos , Infarto del Miocardio con Elevación del ST/mortalidad , Infarto del Miocardio con Elevación del ST/fisiopatología , Tasa de Supervivencia/tendencias , Factores de TiempoRESUMEN
Under-expanded coronary stent related to inadequate preparation of calcified lesion is associated with poor clinical outcomes.Off-label use of S-IVL to correct this clinical issue is effective and safe, probably more than other current techniques. However, this statement needs further evidence.
RESUMEN
OBJECTIVES: To identify systemically detectable vascular inflammation associated to redox system unbalance, advanced oxidation protein products (AOPP), formed by HClO reaction with proteins, Thiol levels, and their ratio (AOPP/Thiol ratio) were measured in patients with acute coronary syndromes (ACS). DESIGN AND METHODS: We evaluated AOPP/Thiol ratio together with CRP and IL-1ß in 18 acute myocardial infarction (AMI) and in 16 unstable angina (UA) patients at admission, and in 16 control subjects (CTR); the measurements were repeated at 1 and at 6 months. RESULTS: At admission, AMI and UA patients displayed higher AOPP/Thiol ratio and CRP and IL-1ß compared to CTR subjects. A correlation between AOPP/Thiols and IL-1ß in AMI was found. At follow-up, in UA only, AOPP/Thiol ratio and IL-1ß levels still remained high. CONCLUSIONS: The AOPP/Thiol ratio seems to affect the inflammatory process in ACS, and may represent a reliable marker of oxidative unbalance in this setting of patients.