Impact Of Symptom Onset-to-First Medical Contact Time On The Prognosis Of Patients With Acute ST-Segment Elevation Myocardial Infarction

Background The onset of acute ST-segment elevation myocardial infarction(STEMI)is nasty,associated with high incidence of complications and mortality.Studies showed that the total ischemic time was significantly related with STEMI patients.With the total ischemic time each extension of 30 minutes,the 1-year mortality rate was increased by 7.5%.Reperfusion time is the key indicators of the measure of early treatment capacity in acute myocardial infarction,especially in STEMI.Many treatment timelines for reperfusion therapy were recommended by domestic and overseas researchers over the 20 years,such as pain-to-balloon time,door-to-balloon(D2B/DTB)time,first medical contact-to-balloon(FMC-to-B)time,Symptom Onset-to-First Medical Contact(SO-to-FMC)time,Symptom Onset-to-balloon(SO-to-B/S2B/STB)time,which can affect the treatment and clinical outcomes of patients with STEMI.The D2 B and FMC-to-B time are currently recommended by the European and American guidelines.However,the previous research on STEMI patients at home and abroad focused on the emergency treatment time after first medical contact,rarely paying attention to the emergency time from the SO-to-FMC(Symptom onset to the first medical contact).Objective To investigate the impact of SO-to-FMC time on other treatment time and prognosis of patients with acute STEMI.Methods The clinical data of 341 consecutive STEMI patients who were admitted to 306 Hospital of PLA from 2011,8 to 2016,4 receiving emergency PPCI were retrospectively studied.The patients were divided into two groups according to the SO-to-FMC time: ≤90min group(n=201)and >90min group(n=140).Treatment time were recorded timely after patients had arrived emergency room.Datas that biomarkers related to myocardial injury and indexes on myocardial tissue perfusion were collected.Short and long-term mortalities and MACCE incidence in hospital or during follow-up period were obtained by means of case inquiry,phone call and Hospital Information System(HIS).The predictors of 1-year mortality after PCI and 1-year incidence of MACCE during the post-discharge follow-up period were analysed by binary logistic regression analysis.The predictor of 4.5-year cumulative mortality after PCI and 4.5-year cumulative incidence of MACCE during the post-discharge follow-up period in patients with STEMI were analysed by multivariate COX regression analysis.Results 1.The ≤90min group was significantly shorter than >90min group in the D2 B time[104(88,125)vs.111(92,144)min,P=0.023],FMC-to-B time[146(119,197)vs.177(125,237)min,P=0.005],and S2 B time[200(170,257)vs.338(270,474)min,P<0.001].2.Apart from In-hospital mortality(2.49% vs.6.43%,P=0.071),The ≤90min group were significantly lower than >90min group in the 30-day mortality(2.99% vs.7.86%,P=0.042),1-year mortality(2.89 vs.9.57,P=0.015),4.5-year cumulative mortality(3.00% vs.11.20%,P=0.007)after PCI and 1-year incidence of MACCE during the post-discharge follow-up period [1.16%(2/173)vs.6.96%(8/115),P=0.021].Morever,the ≤90min group was significantly higher than >90min group in the 4.5-year incidence with free of MACCE(97.20% vs.88.80%,P=0.025)during the post-discharge follow-up period.On binary logistic regression analysis,the “SO-to-FMC time >90min” was the risk predictor of 1-year mortality and 1-year incidence of MACCE during the post-discharge follow-up period(OR 2.90,95%CI 1.22~6.92,P=0.016;OR 5.19,95%CI 1.21~22.20,P=0.026).Multivariate COX regression analysis demonstrated that the “SO-to-FMC time >90min”riskly predicted the 4.5-year mortality after PCI in patients with STEMI(HR 2.88,95%CI 1.10~7.53,P=0.031).3.The single factor analysis showed the rates of “CTFC≤28 or MBG 0/1”achieving of ≤90min group were significant higher than >90min group[79.39(131/166)vs.63.64(77/121),P<0.05;67.76(68/166)vs.46.78(81/121),P<0.001],apart from the comparison of STR and the incidence of Killip≥Ⅱ(P>0.05).On logistic regression analysis,the “SO-to-FMC time >90min”was the independent predictor of CTFC>28 and Killip≥Ⅱ(OR 2.29,95%CI 1.33-3.93,P=0.003;OR=2.03,95% CI 1.08-3.82,P=0.029).However,the “SO-to-FMC time >90min” wasn’t the independent predictor of MBG0/1(OR 2.07,95%CI 0.88-4.89,P=0.098).Conclusions 1.The shorter the SO-to-FMC time,the shorter the corresponding D2 B time,FMC-to-B time and S2 B time.2.“The SO-to-FMC time ≤ 90min” can effectively reduce the incidence of microvascular obstruction,improving the cardiac function of patients.3.“The SO-to-FMC time ≤ 90min” can decrease short and long-term mortalities and the incidence of MACCE.