Primary percutaneous coronary intervention within the first hour: Insights from early-treated patients with ST-elevation myocardial infarction - 02/03/26
, Yinggan Zheng, MA, MEd a, Robert C. Welsh, MD a, Peter R. Sinnaeve, MD, PhD b, c, Frans Van de Werf, MD, PhD c, Cynthia M. Westerhout, PhD a, Kevin R. Bainey, MD, MSc aHighlights |
• | Performing primary percutaneous coronary intervention (PPCI) ≤60 minutes of randomization resulted in a significant reduction in the 30-day composite outcome of all-cause death, shock, heart failure, and reinfarction compared to later treatment. |
• | The incidence of cardiogenic shock at 30 days was substantially reduced by 62% in patients who received PPCI ≤60-minute, highlighting a key mechanism of benefit. |
• | Patients treated ≤60-minutes had a significantly lower proportion of Q waves on their hospital discharge ECG and a lower QRS score, suggesting greater myocardial salvage. |
• | The time difference between the early and later-treated groups translated into an approximately 70-minute reduction in total ischemic time (symptom-onset-to-PPCI) for the <60-minute cohort. |
ABSTRACT |
Background |
Whereas reperfusion benefit in ST-elevation myocardial infarction (STEMI) is time-dependent, outcome data from very early primary percutaneous coronary intervention (PPCI) are limited. The STREAM-1 and -2 trials provided a unique opportunity to assess this issue. We evaluated electrocardiographic (ECG), angiographic, and clinical outcomes of early presenting STEMI patients undergoing PPCI, focusing on those treated <60 minutes of randomization.
Methods |
We analyzed STEMI patients from STREAM-1 ( n = 1,892) and STREAM-2 ( n = 604) trials presenting < 3 hours of symptom onset who underwent PPCI. Endpoints included ECG (ST segment resolution, Q waves), angiographic (TIMI flow grade), 30-day composite of all-cause death, shock, heart failure, reinfarction, safety outcomes, and 1-year mortality.
Results |
Patients undergoing PPCI <60 minutes of randomization (29.2%) were younger, more frequently male, and had shorter total ischemic times than those undergoing PPCI > 60 minutes. ST resolution and TIMI flow outcomes were similar, but significantly fewer patients in the rapid PPCI group had Q waves on discharge ECG (58.2 vs. 71.9%, P < .001). The 30-day composite outcome was lower in the < 60 minutes group (10.1 vs 14.8%, risk ratio [RR] 0.68 [95% confidence interval 0.47-0.98], P = .04), associated with a significant 62% reduction in cardiogenic shock ( P = .0008), and also had lower 1-year mortality (4.0 vs 7.2%; RR 0.56 [0.31-1.01], P (logrank) = .047). After inverse probability weighted adjustment, the 30-day composite outcome and cardiogenic shock were RR 0.74 (0.50-1.08), P = .116 and RR 0.45 (0.22-0.91), P = .027, respectively, and the 1-year mortality was RR 0.70 (0.39-1.26), P = .235. Safety endpoints were similar in both groups.
Conclusions |
Substantial opportunity exists to improve outcomes for early-presenting STEMI patients undergoing PPCI. Establishing a first medical contact-to-PPCI time of <60 minutes provides incremental benefit.
Clinical trial registration |
URL: NCT00623623 , NCT02777580 . Unique identifiers: NCT02777580, NCT00623623 .
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Vol 295
Article 107363- mai 2026 Retour au numéro
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