Association of time to reperfusion with left ventricular function and heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention: a systematic review

Am Heart J. 2013 Apr;165(4):451-67. doi: 10.1016/j.ahj.2012.11.014. Epub 2013 Feb 14.


Background: Shorter time to reperfusion is associated with a significant reduction in mortality; however, its association with heart failure (HF) is not clearly documented. We conducted a systematic review to examine the association between time to reperfusion and incident HF and/or left ventricular dysfunction.

Methods: MEDLINE/OVID, EMBASE, Cochrane Library, and Web of Science databases were searched from January 1974 to May 2012 for studies that reported the association between time to reperfusion and incident HF or left ventricular ejection fraction (LVEF) in patients undergoing primary percutaneous coronary intervention.

Results: Of 362 nonduplicate abstracts, 71 studies were selected for full-text review. Thirty-three studies were included in the final review, of which 16 were single-center studies, 7 were population-based studies, 7 were subanalyses from randomized controlled trials, and 3 were based on national samples. The pooled data demonstrate that every 1-hour delay in time to reperfusion is associated with a 4% to 12% increased risk of new-onset HF and a 4% relative increase in the risk of incident HF during follow-up. Early reperfusion was associated with a 2% to 8% greater LVEF before discharge and a 3% to 12% larger improvement in absolute LVEF at follow-up compared with the index admission.

Conclusions: This systematic review presents evidence that longer time to reperfusion is not only associated with worsened left ventricular systolic function and new-onset HF at the time of index admission, but also with increased risk of HF and reduced improvement in left ventricular systolic function during follow-up.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Comorbidity
  • Heart Failure / epidemiology*
  • Humans
  • Myocardial Infarction / epidemiology*
  • Myocardial Infarction / therapy*
  • Myocardial Reperfusion*
  • Risk Assessment
  • Stroke Volume
  • Systole / physiology
  • Time Factors
  • Vascular Patency
  • Ventricular Dysfunction, Left / epidemiology*
  • Ventricular Function, Left