Primary percutaneous coronary intervention within the first hour: Insights from early-treated patients with ST-elevation myocardial infarction

doi:10.1016/j.ahj.2026.107363

Coronary disease & ACSResearch article

Primary percutaneous coronary intervention within the first hour: Insights from early-treated patients with ST-elevation myocardial infarction

Am Heart JPublished 29 Jan 2026

Analysis of ST-elevation myocardial infarction (STEMI) patients from the STREAM-1 and STREAM-2 trials
inverse probability weighted adjustment

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Authors' conclusion

Substantial opportunity exists to improve outcomes for early-presenting STEMI patients undergoing PPCI. Establishing a first medical contact-to-PPCI time of <60 minutes provides incremental benefit.

Study context

Population: STEMI patients presenting <3 hours of symptom onset who underwent primary percutaneous coronary intervention (PPCI)STREAM-1 1,892 · STREAM-2 604

Comparison: PPCI <60 minutes of randomization vs PPCI >60 minutes

Main finding

As reported in the abstract

ST resolution and TIMI flow

Similar

Further findings

Q waves on discharge ECG · significantly fewer with <60 minutes

P < 0.001

<60 minutes group58.2 %

>60 minutes71.9%

Outcome	<60 minutes group%	>60 minutes	Lower risk with <60 minutes group ←→ Higher risk with <60 minutes group	RR	P value
30-day composite of all-cause death, shock, heart failure, reinfarction	10.1	14.8%		0.68 (95% CI 0.47–0.98)	P = 0.04
30-day composite of all-cause death, shock, heart failure, reinfarction · after inverse probability weighted adjustment				0.74 (CI 0.50–1.08)	P = 0.116
Cardiogenic shock · 30 days · after inverse probability weighted adjustment				0.45 (CI 0.22–0.91)	P = 0.027
1-year mortality	4.0	7.2%		0.56 (CI 0.31–1.01)	P(logrank) = .047
1-year mortality · after inverse probability weighted adjustment				0.70 (CI 0.39–1.26)	P = 0.235
			0.20.5125Relative risk (log scale)

Cardiogenic shock — significant reduction: 62%
Cardiogenic shock — P: P = .0008

Original publication

Primary percutaneous coronary intervention within the first hour: Insights from early-treated patients with ST-elevation myocardial infarction. Am Heart J. Published 29 January 2026. doi:10.1016/j.ahj.2026.107363

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Summarised from the published abstract; every number is checked against it