Abstract
Purpose
The prognosis of door to balloon time (DBT) after primary percutaneous coronary intervention
(PPCI) in ST-segment elevation myocardial infarction (STEMI) has been extensively
studied. However, the clinical implications of the ECG to activation time (EAT), as
a component of DBT, on long-term outcomes are less well established. This study evaluates
the association of EAT with major adverse cardiovascular events (MACEs) in more contemporary
patients undergoing PPCI and investigates factors that influence EAT.
Methods
A total of 1082 consecutive patients with STEMI who underwent PPCI from 2013 to 2019
were classified into 3 groups according to EAT: EAT ≤30 minutes, EAT of 30 to 60 minutes,
and EAT >60 minutes. We analyzed the incidence of MACEs, including all-cause death,
nonfatal recurrence of MI, or nonfatal stroke during a median follow-up of 37 months.
Findings
The median EAT was 58 minutes (interquartile range, 44–80 minutes), which explained
90% of the variability in DBT and had the strongest correlation with DBT (r = 0.95, P < 0.001). Achieving an EAT of ≤30 minutes resulted in a 94.1% chance of achieving
a DBT ≤90 minutes. The incidence of MACEs had a concurrent increase with increased
EAT (10.2% for EAT ≤30 minutes, 14.3% for EAT of 30–60 minutes, and 17.3% for EAT
>60 minutes; P = 0.027) that was driven by more mortality (4.2% for EAT ≤30 minutes, 6.9% for EAT
of 30–60 minutes, and 9.8% for EAT >60 minutes; P = 0.020). An EAT >30 minutes was independently associated with risk-adjusted long-term
MACEs (hazard ratio = 1.99; 95% CI, 1.07–3.69; P = 0.030). Critically ill status in emergency department (P = 0.001) and time required for consent of revascularization (P < 0.001) were significantly associated with delayed EAT.
Implications
Achieving an EAT ≤30 minutes was key to achieving the guideline-recommended target
time of DBT in contemporary practice. As a strong driver of overall DBT, EAT >30 minutes
was associated with worse clinical outcome in patients with STEMI undergoing PPCI.
These data suggest that efforts to minimize EAT are needed to reduce long-term MACEs
in contemporary population. © 2021 Elsevier HS Journals, Inc.
Key words
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Article info
Publication history
Published online: November 05, 2021
Accepted:
October 12,
2021
Identification
Copyright
© 2021 Published by Elsevier Inc.
