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Patients with ST-segment elevation of myocardial infarction miss out on early reperfusion: when to undergo delayed
Wen Zheng1,2, Cheuk-Man Yu3, Jing Liu1
1Department of Epidemiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, No.2 Anzhen Road, Chaoyang District, Beijing, China.
Insights
Optimal timing for delayed percutaneous coronary intervention (PCI) after ST-segment elevation myocardial infarction (STEMI) is crucial. Performing PCI in the second week post-STEMI offers improved survival benefits and reduced adverse events for stable patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Many ST-segment elevation myocardial infarction (STEMI) patients miss early reperfusion therapy, even with primary percutaneous coronary intervention (PCI).
- Optimal timing for delayed PCI in stable STEMI patients remains debated, impacting clinical outcomes.
Purpose of the Study:
- To determine the optimal timing for delayed PCI in stable STEMI patients who did not receive early reperfusion.
- To evaluate the association between delayed PCI timing and major adverse cardiovascular events (MACEs).
Main Methods:
- Retrospective analysis of 5,417 STEMI patients undergoing delayed PCI (2-28 days post-STEMI) between 2007-2010.
- Exclusion of hemodynamically unstable patients; primary outcome was MACEs over 1-year follow-up.
- Patients categorized into Early (2-7 days), Medium (8-14 days), and Late (15-28 days) PCI groups.
Main Results:
- The Medium PCI group (8-14 days) showed a significantly lower incidence of MACEs compared to the Late group (15-28 days).
- The Medium group experienced fewer recurrent myocardial infarctions plus cardiac deaths and less repeat revascularization compared to the Early group (2-7 days).
- Analysis revealed the lowest MACE incidence occurred at approximately 14 days post-STEMI.
Conclusions:
- Delayed PCI timing in real-world practice varies significantly.
- Undergoing PCI during the second week after STEMI provides superior survival benefits and fewer adverse events for stable patients without early reperfusion.
Objective:
There are still a high proportion of patients with ST-segment elevation myocardial infarction (STEMI) missing out early reperfusion even in the primary percutaneous coronary intervention (PCI) era. Most of them are stable latecomers, but the optimal time to undergo delayed PCI for stable ones remains controversial.
Methods:
We investigated all STEMI patients who underwent delayed PCI (2-28 days after STEMI) during 2007-2010 in Beijing and excluded patients with hemodynamic instability. The primary outcome was major adverse cardiovascular events (MACEs).
Results:
This study finally enrolled 5,417 STEMI patients and assigned them into three groups according to individual delayed time (Early group, 55.9%; Medium group, 35.4%; Late group, 8.7%). During 1-year follow-up, MACEs occurred in 319 patients. The incidence of MACEs were respectively 7.1%, 5.6% and 6.7% among three groups. The Medium group had less recurrent myocardial infarction plus cardiac death (hazard ratio, 0.525; 95% confidence interval, 0.294-0.938, P = 0.030) than Late group and less repeat revascularization (hazard ratio, 0.640; 95% confidence interval, 0.463-0.883, P = 0.007) than Early group in pairwise comparisons. We depicted the incidence of major adverse cardiovascular event (MACE) by delayed time as a quadratic curve and found the bottom appeared at day 14.
Conclusions:
The delayed PCI time varied in the real-world practice, but undergoing operations on the second week after STEMI had greater survival benefit and less adverse events for whom without early reperfusion and hemodynamic instability.
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