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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Treatment Windows and Clinical Outcomes in Late-Presenting Patients with ST-Segment Elevation Myocardial Infarction
Ming Gao1, Ling Qin1, Zhiguo Zhang1
1Department of Cardiology, The First Hospital of Jilin University, Changchun, Jilin, China.
Insights
For ST-segment elevation myocardial infarction (STEMI) patients over 12 hours from symptom onset, percutaneous coronary intervention (PCI) within 7 days did not increase recurrent heart attacks, except in cases of multivessel disease.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- ST-segment elevation myocardial infarction (STEMI) often requires reperfusion therapy.
- Percutaneous coronary intervention (PCI) is a common strategy for STEMI.
- Optimal timing for PCI in prolonged STEMI (>12 hours) remains debated.
Purpose of the Study:
- To evaluate the impact of PCI timing on long-term outcomes in STEMI patients with delayed presentation.
- To assess the relationship between symptom onset-to-balloon inflation time and recurrent myocardial infarction (MI) or mortality.
Main Methods:
- A real-world cohort of 825 STEMI patients presenting >12 hours after symptom onset was analyzed.
- Patients undergoing primary PCI were grouped into treatment within ≤7 days or >7 days.
- Primary endpoints included nonfatal recurrent MI and all-cause mortality at 2 years.
Main Results:
- Two-year cumulative rates for recurrent nonfatal MI were 4.1% (≤7 days) vs. 3.3% (>7 days), P=0.049.
- Mortality rates at 2 years were 3.4% (≤7 days) vs. 4.7% (>7 days), P=0.238.
- Symptom onset-to-balloon inflation time was not an independent predictor of recurrent MI or mortality after adjustment.
Conclusions:
- PCI within 7 days of symptom onset in STEMI patients presenting >12 hours did not correlate with increased nonfatal recurrent MI.
- An exception was noted in patients with multivessel coronary artery disease, where early PCI showed higher recurrent MI rates.
- Timing of PCI in this delayed presentation STEMI group requires careful consideration, especially in multivessel disease scenarios.
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.
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