Treatment Windows and Clinical Outcomes in Late-Presenting Patients with ST-Segment Elevation Myocardial Infarction.

Abstract

BACKGROUND:

Percutaneous coronary intervention (PCI) is the reperfusion strategy typically used in patients with ST-segment elevation myocardial infarction (STEMI) who present with prolonged ischemic symptoms (>12 hours after onset). However, there is no consensus on an optimal time window for PCI. We examined a real-world cohort, assessing time from symptom onset to balloon inflation in relation to long-term nonfatal recurrent myocardial infarction (MI) or all-cause mortality.

MATERIALS AND METHODS:

A total of 825 consecutive patients presenting with ischemic symptoms of STEMI >12 hours after symptom onset and undergoing subsequent primary PCI were grouped by time-to-treatment status (≤7 days or >7 days post-MI). Primary endpoints were nonfatal recurrent MI and all-cause mortality.

RESULTS:

Cumulative rates of recurrent nonfatal MI at 2 years were 4.1% and 3.3% in patients with symptom-onset-to-balloon inflation times of ≤7 days and >7 days, respectively (P = 0.049); and corresponding mortality rates were 3.4% and 4.7% (P = 0.238). In Cox multivariate analyses, syndrome-onset-to-balloon-inflation time was not independently predictive of recurrent MI (P = 0.052) or mortality (P = 0.651) at 2 years, once adjusted for certain clinical and angiographic variables known to influence patient outcomes. The 2-year rate of recurrent MI was highest in patients with multivessel coronary artery diseases undergoing primary PCI ≤7 days after symptom onset to balloon inflation (P = 0.005).

CONCLUSIONS:

In patients presenting with ischemic signs or symptoms of STEMI >12 hours after initial symptom onset and treated by PCI, symptom-onset-to-balloon-inflation times ≤7 days showed no relation to nonfatal recurrent MI, unless in the presence of multivessel coronary artery diseases.

• Authors: Ming Gao, Ling Qin, Zhiguo Zhang, Liping Chen, Yang Zheng, Qian Tong, Quan Liu
• Journal: The American journal of the medical sciences (Am J Med Sci) Vol. 358 Issue 4 Pg. 248-255 (10 2019) ISSN: 1538-2990 [Electronic] United States
• PMID: 31327461 (Publication Type: Journal Article, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2019 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.

Topics

• Aged
• Female
• Humans
• Male
• Middle Aged
• Percutaneous Coronary Intervention
• Propensity Score
• Proportional Hazards Models
• ST Elevation Myocardial Infarction (mortality, therapy)
• Time-to-Treatment
• Treatment Outcome