Abstract 11928: An Interaction Between The Time Delay And Pharmacologic Pre-treatment. Effect On Myocardial Perfusion And Infarct Size

• Published in: Circulation (New York, N.Y.) N.Y.), 2015-11, Vol.132 (Suppl_3 Suppl 3), p.A11928-A11928
• Main Authors: Prech, Marek, Bartela, Ewa, Janus, Magdalena, Araszkiewicz, Aleksander, Jeremicz, Igor, Kutrowska, Aleksandra, Pyda, Malgorzata
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/circ.132.suppl_3.11928

IntroductionPrimary percutaneous coronary intervention (PCI) is the preferred method of reperfusion in STEMI patients. However, optimal adjunctive pharmacotherapy is still under investigation.HypothesisTo assess the effect of triple pharmacologic therapy on myocardial perfusion and infarct size in relation to different time delays.MethodsWe studied 309 consecutive STEMI patients admitted within 12 hours from symptom onset with(1) chest pain persisting for >30min, (2) ST-segment elevation >1mm in ≥ 2 contiguous leads, (4) pre-treatment with 600mg of clopidogrel, 300mg of aspirin and 5000U of intravenous heparin. Group I (n=90) comprised patients transferred immediately to cathlab, group II (n=219) consisted of patients transferred via local hospitals (staged transfer). Results of TIMI flow prior to PCI and post-PCI, ST-segment resolution, troponin T level and MBG were analyzed in relation to time delay to intervention.ResultsThe median time interval between the onset of symptoms and pharmacologic pre-treatment was comparable in both groups, but the delay between pharmacologic pre-treatment and angiography was twice longer in cases of staged transfer. Despite a longer delay to intervention, higher rates of pre-angiography total ST-segment resolution (STSR) and TIMI flow 3 at initial angiography were observed in those patients. Differences in the rate of total STSR, TIMI flow 3 and MBG were no longer observed post PCI. Similarly, the peak troponin level was comparable in both groups - table.Conclusions1. Pre-hospital treatment with a combination of antiplatelet and antithrombotic agents improves myocardial perfusion.2. Longer transfer delay paradoxically allows for the amplification of pharmacologic pre-treatment before mechanical reperfusion.