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Background Microvascular obstruction affects one-half of patients with ST-segment elevation myocardial infarction and confers an adverse prognosis. Objectives This study aimed to determine whether the efficacy and safety of a therapeutic strategy involving low-dose intracoronary alteplase infused early after coronary reperfusion associates with ischemic time. Methods This study was conducted in a prospective, multicenter, parallel group, 1:1:1 randomized, dose-ranging trial in patients undergoing primary percutaneous coronary intervention. Ischemic time, defined as the time from symptom onset to coronary reperfusion, was a pre-specified subgroup of interest. Between March 17, 2016, and December 21, 2017, 440 patients, presenting with ST-segment elevation myocardial infarction within 6 h of symptom onset (, Central Illustration

Symptom to door time, a constituent of total ischemic time is an important prognostic determinant. Current ECG recording involving long cables and training for their proper connection is major hindrance for home ECG recording. Torso limb electrode positions are both delto-pectoral grooves, right

Door to balloon (DTB) time is a well established determinant of in-hospital outcome and long-term morbidity and mortality in the ST Elevation Myocardial Infarction (STEMI), however, significance of total ischemic time (TIT) is debatable. Therefore, aim of this study was to evaluate the association

Patients with ST-segment elevation myocardial infarction (STEMI) initially presenting to non–percutaneous coronary intervention (PCI)-capable hospitals are frequently transferred to PCI-capable hospitals, and consequently, they have longer total ischemic time and worse outcomes. Potential targets

Troponin release in ST elevation myocardial infarction (STEMI) has predictable kinetics and is a robust marker of ischemic time. We evaluated the relationship between presenting troponin levels and in-hospital mortality in STEMI patients (pts) undergoing primary percutaneous coronary intervention (

To search independent influencing factors of total ischemic time in primary percutaneous coronary intervention. ST segment elevation myocardial infarction patients who received primary percutaneous coronary intervention between January 2009 and December 2012 in Nanjing Drum-tower hospital were

In this issue of the Journal , Francone et al. ([1][1]) report an analysis of the relationship between time from the onset of symptoms to reperfusion (ischemic time) in ST-segment elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI). These

Primary percutaneous coronary intervention (PPCI) provided in a timely fashion is the treatment of choice for patients presenting with STEMI. Total ischemic time during STEMI (time from the onset of symptoms to successful reperfusion) is a predictor of adverse outcomes. Several studies have examined

The annual Bruckenberger Report using ICD-10 data demonstrated large differences in outcomes of patients with MI between the different federal states in Germany. The federal state Rheinland-Pfalz (RLP) showed increased mortality rates above the mean for Germany. In cooperation with the health

Current guidelines for ST- elevation myocardial infarction (STEMI) recommend early revascularization with optimal ischemic time (IT)

Repeated short episodes of coronary occlusion in experimental animals cause myocardial preconditioning which reduces the extent of further ischemia. The purpose of the present study was to assess whether preconditioning also occurs during repeated exercise induced ischemia. Twenty-six coronary patients with positive exercise tests had 3 treadmill exercise tests at 30 minutes intervals. Two additional stress tests were performed on each of the previous 2 days, in order to eliminate/reduce the training effect. The 1st exercise test was regarded as baseline, while the 2nd (ex-2) and 3rd (ex-3) were compared to the 1st. Time to 1 mm ST depression (STD), recovery time (from maximal ischemia to 1 mm STD), total ischemic time (from 1 mm STD during exercise to regression of ischemia to 1 mm), double product at 1 mm STD and exercise duration were assessed. Exercise p 1 2 3 1 vs 2 1 vs 3 Time to 1mm (sec) 487 593 572 0004 0021 Recovery Time (sec) 259 126 109 00001 000002 Total Ischemic Time (sec) 633 399 430 00001 0002 Double Product at 1mm 20322 22325 21298 0008 0.163 Exercise Duration (sec) 862 864 885 0887 0.235 Preconditioning (defined as an improvement of 10% or more) was seen in 2 or more parameters in 76% of the patients. These data indicate that total ischemic time and recovery time were markedly reduced and that time to 1 mm STD was prolonged and the double product at 1 mm of STD (ischemic threshold) was higher in the second exercise. This is the first evidence that myocardial preconditioning occurs during repeated exercise induced ischemia.

Infarct size reduction after ischemic preconditioning has been reported as an all-or-nothing response, with a threshold of 2 to 5 min of preconditioning ischemia time. Furthermore, infarct size reduction is associated with glycogen depletion before prolonged ischemia. We sought to determine whether increasing preconditioning ischemia time results in progressive myocardial glycogen depletion and infarct size reduction and if so, whether infarct size reduction correlates with glycogen depletion before prolonged ischemia. Therefore, ventilated rats underwent a single episode of preconditioning ischemia lasting 1.25 (n = 18), 2.5 (n = 20), 5 (n = 9), or 10 (n = 16) min, or multiple episodes cumulating in 10 (2 × 5 min, n = 17) or 20 (4 × 5 min, n = 13 or 2 × 10 min, n = 14) min of preconditioning ischemia time, all followed by 5 min of reperfusion. Control rats (n = 22) were not preconditioned. In separate groups, glycogen was determined before whereas infarct size was determined after prolonged ischemia (45 min) and reperfusion 120 min). Myocardial glycogen levels and infarct size are shown as a function of preconditioning ischemia time. Download : Download high-res image (103KB) Download : Download full-size image In addition, infarct size reduction correlated with glycogen depletion before prolonged ischemia (r = 0.98; 19 P l 0.001). Thus, increasing preconditioning ischemia time results in progressive myocardial glycogen depletion and infarct size reduction, reaching a maximal effect when the preconditioning ischemia time is ≥5 min. This maximal effect may be due to marked depletion of myocardial glycogen stores before prolonged ischemia

The pan-London PPCI network uses a 24/7 “Paramedic Activated” service model with the London Ambulance Service (LAS) across 8 Cardiac Centres - paramedics autonomously activate the PPCI service from the community. This model aims to reduce ischemia time by autonomous paramedic activation. Our