This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
Research Article
Zuzana Motovska
Univerzita Karlova 3 lekarska fakulta
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5319-473X
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Purpose: Based on previous studies with clopidogrel, the time between onset of symptoms and primary PCI was proven as an important prognostic factor. Our aim was to assess the effect of symptoms onset to needle time (SNT) on procedural results and on the occurrence of ischemic endpoints in primary angioplasty patients treated with potent P2Y12 inhibitors.
Methods: A total of 1,131 out of 1,230 patients randomized to the PRAGUE 18 study (prasugrel vs. ticagrelor in primary angioplasty) were divided into a high and a low-risk group. The effect of defined SNT on patients' ischemic endpoints and prognosis by their risk status at admission was tested.
Results: The median SNT was 3.2 hours. Longer SNTs resulted in a more frequent incidence of TIMI flow < 3 post PCI (p = 0.015). There were significant differences in the occurrence of the combined ischemic endpoint among the compared SNT groups at 30 days (p=0.032), and 1 year (p=0.011), with the highest incidence in the ≤ 1 h SNT group of patients. "Latecomers" (SNT > 4 hs) in the high-risk group experienced more reMI within 1 year [OR (95% CI) 3.23 (1.09–9.62) p = 0.035]; no difference was found in the low-risk group.
Conclusion: In the era of intense antithrombotic medication, stratification of STEMI patients undergoing primary angioplasty, based on initial ischemic risk assessment affected prognosis more than symptom onset to needle time. Longer time delay significantly increased the incidence of ischemic events and all-cause mortality only in patients with high ischemic risk.
Keywords
STEMI, symptoms onset to needle time, risk stratification, P2Y12 inhibitors, ischemic endpoints
Figure 1
Loading...
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 18 May, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Learn more about our company.
A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Research Article
Zuzana Motovska
Univerzita Karlova 3 lekarska fakulta
Corresponding Author
ORCiD: https://orcid.org/0000-0002-5319-473X
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
History
CURRENT STATUS: Posted
Version 1
Posted 18 May, 2021
No community comments so far
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Purpose: Based on previous studies with clopidogrel, the time between onset of symptoms and primary PCI was proven as an important prognostic factor. Our aim was to assess the effect of symptoms onset to needle time (SNT) on procedural results and on the occurrence of ischemic endpoints in primary angioplasty patients treated with potent P2Y12 inhibitors.
Methods: A total of 1,131 out of 1,230 patients randomized to the PRAGUE 18 study (prasugrel vs. ticagrelor in primary angioplasty) were divided into a high and a low-risk group. The effect of defined SNT on patients' ischemic endpoints and prognosis by their risk status at admission was tested.
Results: The median SNT was 3.2 hours. Longer SNTs resulted in a more frequent incidence of TIMI flow < 3 post PCI (p = 0.015). There were significant differences in the occurrence of the combined ischemic endpoint among the compared SNT groups at 30 days (p=0.032), and 1 year (p=0.011), with the highest incidence in the ≤ 1 h SNT group of patients. "Latecomers" (SNT > 4 hs) in the high-risk group experienced more reMI within 1 year [OR (95% CI) 3.23 (1.09–9.62) p = 0.035]; no difference was found in the low-risk group.
Conclusion: In the era of intense antithrombotic medication, stratification of STEMI patients undergoing primary angioplasty, based on initial ischemic risk assessment affected prognosis more than symptom onset to needle time. Longer time delay significantly increased the incidence of ischemic events and all-cause mortality only in patients with high ischemic risk.
Figure 1
Loading...