Clinical characteristics and reperfusion times among patients with an isolated posterior myocardial infarction

Stephen W. Waldo, Ehrin J. Armstrong, Ameya Kulkarni, Kurt S. Hoffmayer, Priscilla Hsue, Peter Ganz, James M. McCabe

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

BACKGROUND: An isolated posterior myocardial infarction (PMI) is associated with significant morbidity and mortality. Because physicians often fail to recognize this diagnosis, there may be delays in the timely revascularization of these patients. The present study sought to identify the clinical characteristics and reperfusion times among patients presenting with isolated PMI. METHODS: We identified subjects with isolated PMI within a registry of all catheterization laboratory activations for ST-elevation myocardial infarction (STEMI) from 2008 to 2012. Association between PMI and revascularization within 90 minutes was evaluated by logistic regression. RESULTS: Among 318 patients who underwent revascularization for STEMI, a total of 20 (6%) had electrocardiographic evidence of an isolated PMI. Compared to non-PMI STEMI, subjects with PMI were more often female (45% vs 22%; P≤.02) and less likely to have chest pain (40% vs 75%; P<.01). The median door-to-activation (25.5 min vs 12 min; P<.01), activation-to-laboratory (36.5 min vs 29 min; P<.01) and door-to-balloon times (107 min vs 72 min; P<.01) were longer among subjects with PMI, with fewer patients achieving reperfusion within 90 minutes (30% vs 71%; P<.01). After multivariable adjustment, individuals with PMI had 82% lower odds (adjusted odds ratio, 0.18; 95% confidence interval, 0.06-0.50) of achieving coronary reperfusion within 90 minutes. Door-to-activation time accounted for 96% of variation in the total revascularization time (R2≤0.96; P<.0001). CONCLUSIONS: Door-to-activation time was prolonged for those with PMI, resulting in longer door-to-balloon times and fewer patients revascularized within the recommended time. An isolated PMI should be considered among individuals presenting with symptoms consistent with myocardial infarction..

Original languageEnglish (US)
Pages (from-to)371-375
Number of pages5
JournalJournal of Invasive Cardiology
Volume25
Issue number8
StatePublished - Aug 2013

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Reperfusion
Myocardial Infarction
Myocardial Revascularization
Myocardial Reperfusion
Chest Pain
Catheterization
Registries
Logistic Models
Odds Ratio
Confidence Intervals
Morbidity
Physicians
Mortality

Keywords

  • acute coronary syndromes
  • posterior myocardial infarction
  • reperfusion time

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

Waldo, S. W., Armstrong, E. J., Kulkarni, A., Hoffmayer, K. S., Hsue, P., Ganz, P., & McCabe, J. M. (2013). Clinical characteristics and reperfusion times among patients with an isolated posterior myocardial infarction. Journal of Invasive Cardiology, 25(8), 371-375.

Clinical characteristics and reperfusion times among patients with an isolated posterior myocardial infarction. / Waldo, Stephen W.; Armstrong, Ehrin J.; Kulkarni, Ameya; Hoffmayer, Kurt S.; Hsue, Priscilla; Ganz, Peter; McCabe, James M.

In: Journal of Invasive Cardiology, Vol. 25, No. 8, 08.2013, p. 371-375.

Research output: Contribution to journalArticle

Waldo, SW, Armstrong, EJ, Kulkarni, A, Hoffmayer, KS, Hsue, P, Ganz, P & McCabe, JM 2013, 'Clinical characteristics and reperfusion times among patients with an isolated posterior myocardial infarction', Journal of Invasive Cardiology, vol. 25, no. 8, pp. 371-375.
Waldo SW, Armstrong EJ, Kulkarni A, Hoffmayer KS, Hsue P, Ganz P et al. Clinical characteristics and reperfusion times among patients with an isolated posterior myocardial infarction. Journal of Invasive Cardiology. 2013 Aug;25(8):371-375.
Waldo, Stephen W. ; Armstrong, Ehrin J. ; Kulkarni, Ameya ; Hoffmayer, Kurt S. ; Hsue, Priscilla ; Ganz, Peter ; McCabe, James M. / Clinical characteristics and reperfusion times among patients with an isolated posterior myocardial infarction. In: Journal of Invasive Cardiology. 2013 ; Vol. 25, No. 8. pp. 371-375.
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abstract = "BACKGROUND: An isolated posterior myocardial infarction (PMI) is associated with significant morbidity and mortality. Because physicians often fail to recognize this diagnosis, there may be delays in the timely revascularization of these patients. The present study sought to identify the clinical characteristics and reperfusion times among patients presenting with isolated PMI. METHODS: We identified subjects with isolated PMI within a registry of all catheterization laboratory activations for ST-elevation myocardial infarction (STEMI) from 2008 to 2012. Association between PMI and revascularization within 90 minutes was evaluated by logistic regression. RESULTS: Among 318 patients who underwent revascularization for STEMI, a total of 20 (6{\%}) had electrocardiographic evidence of an isolated PMI. Compared to non-PMI STEMI, subjects with PMI were more often female (45{\%} vs 22{\%}; P≤.02) and less likely to have chest pain (40{\%} vs 75{\%}; P<.01). The median door-to-activation (25.5 min vs 12 min; P<.01), activation-to-laboratory (36.5 min vs 29 min; P<.01) and door-to-balloon times (107 min vs 72 min; P<.01) were longer among subjects with PMI, with fewer patients achieving reperfusion within 90 minutes (30{\%} vs 71{\%}; P<.01). After multivariable adjustment, individuals with PMI had 82{\%} lower odds (adjusted odds ratio, 0.18; 95{\%} confidence interval, 0.06-0.50) of achieving coronary reperfusion within 90 minutes. Door-to-activation time accounted for 96{\%} of variation in the total revascularization time (R2≤0.96; P<.0001). CONCLUSIONS: Door-to-activation time was prolonged for those with PMI, resulting in longer door-to-balloon times and fewer patients revascularized within the recommended time. An isolated PMI should be considered among individuals presenting with symptoms consistent with myocardial infarction..",
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AU - Waldo, Stephen W.

AU - Armstrong, Ehrin J.

AU - Kulkarni, Ameya

AU - Hoffmayer, Kurt S.

AU - Hsue, Priscilla

AU - Ganz, Peter

AU - McCabe, James M.

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N2 - BACKGROUND: An isolated posterior myocardial infarction (PMI) is associated with significant morbidity and mortality. Because physicians often fail to recognize this diagnosis, there may be delays in the timely revascularization of these patients. The present study sought to identify the clinical characteristics and reperfusion times among patients presenting with isolated PMI. METHODS: We identified subjects with isolated PMI within a registry of all catheterization laboratory activations for ST-elevation myocardial infarction (STEMI) from 2008 to 2012. Association between PMI and revascularization within 90 minutes was evaluated by logistic regression. RESULTS: Among 318 patients who underwent revascularization for STEMI, a total of 20 (6%) had electrocardiographic evidence of an isolated PMI. Compared to non-PMI STEMI, subjects with PMI were more often female (45% vs 22%; P≤.02) and less likely to have chest pain (40% vs 75%; P<.01). The median door-to-activation (25.5 min vs 12 min; P<.01), activation-to-laboratory (36.5 min vs 29 min; P<.01) and door-to-balloon times (107 min vs 72 min; P<.01) were longer among subjects with PMI, with fewer patients achieving reperfusion within 90 minutes (30% vs 71%; P<.01). After multivariable adjustment, individuals with PMI had 82% lower odds (adjusted odds ratio, 0.18; 95% confidence interval, 0.06-0.50) of achieving coronary reperfusion within 90 minutes. Door-to-activation time accounted for 96% of variation in the total revascularization time (R2≤0.96; P<.0001). CONCLUSIONS: Door-to-activation time was prolonged for those with PMI, resulting in longer door-to-balloon times and fewer patients revascularized within the recommended time. An isolated PMI should be considered among individuals presenting with symptoms consistent with myocardial infarction..

AB - BACKGROUND: An isolated posterior myocardial infarction (PMI) is associated with significant morbidity and mortality. Because physicians often fail to recognize this diagnosis, there may be delays in the timely revascularization of these patients. The present study sought to identify the clinical characteristics and reperfusion times among patients presenting with isolated PMI. METHODS: We identified subjects with isolated PMI within a registry of all catheterization laboratory activations for ST-elevation myocardial infarction (STEMI) from 2008 to 2012. Association between PMI and revascularization within 90 minutes was evaluated by logistic regression. RESULTS: Among 318 patients who underwent revascularization for STEMI, a total of 20 (6%) had electrocardiographic evidence of an isolated PMI. Compared to non-PMI STEMI, subjects with PMI were more often female (45% vs 22%; P≤.02) and less likely to have chest pain (40% vs 75%; P<.01). The median door-to-activation (25.5 min vs 12 min; P<.01), activation-to-laboratory (36.5 min vs 29 min; P<.01) and door-to-balloon times (107 min vs 72 min; P<.01) were longer among subjects with PMI, with fewer patients achieving reperfusion within 90 minutes (30% vs 71%; P<.01). After multivariable adjustment, individuals with PMI had 82% lower odds (adjusted odds ratio, 0.18; 95% confidence interval, 0.06-0.50) of achieving coronary reperfusion within 90 minutes. Door-to-activation time accounted for 96% of variation in the total revascularization time (R2≤0.96; P<.0001). CONCLUSIONS: Door-to-activation time was prolonged for those with PMI, resulting in longer door-to-balloon times and fewer patients revascularized within the recommended time. An isolated PMI should be considered among individuals presenting with symptoms consistent with myocardial infarction..

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