The impact of total ischemic time on in-hospital mortality and complications in patients with ST-elevation myocardial infarction

The central treatment for acute ST-elevation myocardial infarction (STEMI) is myocardial reperfusion with primary percutaneous coronary intervention (PCI), which must be done quickly. The total ischemic time (TIT), measured from symptom onset to the provision of reperfusion therapy, is critical for the prognosis of STEMI patients.

the purpose of this study was to examine the impact of TIT on in-hospital complications in patients with acute STEMI.

The study included 971 patients. The patients were split into four groups based on the TIT value: Group 1 (<3 hours), Group 2 (≥ 3 and < 6 hours), Group 3 (≥6 hours and < 9 hours), and Group 4 (≥ 9 and < 12 hours).

The incidence rates of complications including atrial fibrillation (AF), ventricular tachycardia (VT), ventricular fibrillation (VF), high-degree atrioventricular (AV) block, in-hospital pneumonia, and in-hospital death were compared across these groups. Chi-square tests were employed to assess statistical significance.

The analysis revealed a statistically significant increase in the incidence of AF: Group 1 5.0%, Group 2 7.5%, Group 3 10.0% and Group 4 12.5% (p = 0.041), VF Group 1 2.5%, Group 2 3.5%, Group 3 5% and Group 4 7% (p = 0.048), in-hospital pneumonia Group 1 4.0%, Group 2 5.5%, Group 3 7.0% and Group 4 9.0% (p = 0.029), and in-hospital death Group 1 2.0%, Group 2 3.0%, Group 3 4.5% and Group 4 6.5% (p = 0.031) with longer TIT. No significant associations were found between TIT and the incidence of VT: Group 1 3.0%, Group 2 4.5%, Group 3 6.0%, Group 4 8.0% (p = 0.105), and high degree AV block Group 1 1.0%, Group 2 2.0%, Group 3 3.0% and Group 4 4.0% (p = 0.129). Patients in Group 4 had significantly higher AF rates than those in Groups 1 and 2( p < 0.05). Group 4 exhibited a significantly higher incidence of VF than Group 1( p < 0.05). The incidence of in-hospital pneumonia was significantly higher in Group 4 compared to Groups 1 and 2( p < 0.05). In-hospital mortality rates were significantly higher in Group 4 compared to Groups 1 and 2 ( p < 0.05).

Patients with longer TIT are at higher risk for certain complications compared to those with shorter ischemic times. Prolonged TIT is significantly associated with higher rates of AF, VF, in-hospital pneumonia, and in-hospital mortality. These findings underline the importance of minimizing ischemic time to improve patient outcomes.