Benefit of percutaneous coronary intervention in early latecomers with acute ST-segment elevation myocardial...

Area of Science:

• Cardiology
• Interventional Cardiology

Background:

• The benefit of percutaneous coronary intervention (PCI) in stable patients with ST-segment elevation myocardial infarction (STEMI) presenting late (12-72 hours after symptom onset) remains debated.
• Previous studies often excluded these 'latecomer' patients or focused on those with immediate high-risk features.

Purpose of the Study:

• To evaluate the efficacy and clinical benefit of PCI compared to medical treatment in stable patients with STEMI presenting between 12 and 72 hours after symptom onset.
• To assess the 12-month clinical outcomes, including mortality and major adverse cardiac events, in this specific patient population.

Main Methods:

• A study involving 2,344 stable STEMI patients presenting 12-72 hours post-symptom onset.
• Exclusion criteria included impaired hemodynamics or prior fibrinolysis/immediate/urgent PCI.
• Patients were allocated to either a PCI group (n=1,889) or a medical treatment group (n=455), with outcomes compared after propensity score adjustment.

Main Results:

• After propensity score adjustment, the PCI group demonstrated significantly lower 12-month mortality (3.1% vs. 10.1%; HR 0.31) compared to the medical treatment group.
• The incidence of a composite endpoint of death or myocardial infarction was also significantly lower in the PCI group (3.8% vs. 11.2%; HR 0.36).
• These benefits were consistent across subgroups, including patients who did not present with chest pain.

Conclusions:

• In stable STEMI patients presenting 12 to 72 hours after symptom onset, PCI is associated with a significant improvement in 12-month clinical outcomes.
• PCI reduces mortality and the composite of death/myocardial infarction in this late-presenting STEMI population.
• The findings support the consideration of PCI in selected stable STEMI patients beyond the traditional early window.