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Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Clinical outcome following late reperfusion with percutaneous coronary intervention in patients with ST-segment
Lars Nepper-Christensen1, Jacob Lønborg1, Dan Eik Høfsten1
1Department of Cardiology, Copenhagen University Hospital, Denmark.
Insights
Patients with ST-elevation myocardial infarction (STEMI) experiencing delayed treatment beyond 12 hours show significantly worse outcomes. Early primary percutaneous coronary intervention is crucial for improving survival and reducing heart failure hospitalizations in STEMI patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Public Health
Background:
- A significant proportion of ST-elevation myocardial infarction (STEMI) patients present for treatment more than 12 hours after symptom onset.
- Clinical outcomes for STEMI patients receiving primary percutaneous coronary intervention (PCI) after a 12-hour delay remain understudied.
Purpose of the Study:
- To investigate the association between delayed primary PCI (≥12 hours) and clinical outcomes in a contemporary STEMI cohort.
- To evaluate the impact of late presentation on mortality and heart failure hospitalizations in STEMI patients.
Main Methods:
- A large cohort of STEMI patients undergoing primary PCI in eastern Denmark (2009-2016) was analyzed.
- Patients were stratified based on PCI timing: <12 hours versus ≥12 hours post-symptom onset.
- The combined endpoint of all-cause mortality and heart failure hospitalization was tracked using nationwide registries.
Main Results:
- 8% of 6674 STEMI patients received PCI ≥12 hours after symptom onset.
- Long-term cumulative rates for the combined endpoint were higher in the late PCI group (37%) compared to the early PCI group (25%).
- Late presentation (≥12 hours) was independently associated with a 42% increased risk of adverse clinical outcomes (HR 1.42, P<0.001).
Conclusions:
- Delayed primary PCI in STEMI patients, particularly beyond 12 hours, is linked to poorer clinical outcomes.
- Increasing the time from symptom onset to primary PCI correlates with a higher risk of adverse events.
- Timely intervention remains critical for managing STEMI and improving patient prognosis.
Background:
Up to 40% of patients with ST-segment elevation myocardial infarction (STEMI) present later than 12 hours after symptom onset. However, data on clinical outcomes in STEMI patients treated with primary percutaneous coronary intervention 12 or more hours after symptom onset are non-existent. We evaluated the association between primary percutaneous coronary intervention performed later than 12 hours after symptom onset and clinical outcomes in a large all-comer contemporary STEMI cohort.
Methods:
All STEMI patients treated with primary percutaneous coronary intervention in eastern Denmark from November 2009 to November 2016 were included and stratified by timing of the percutaneous coronary intervention. The combined clinical endpoint of all-cause mortality and hospitalisation for heart failure was identified from nationwide Danish registries.
Results:
We included 6674 patients: 6108 (92%) were treated less than 12 hours and 566 (8%) were treated 12 or more hours after symptom onset. During a median follow-up period of 3.8 (interquartile range 2.3-5.6) years, 30-day, one-year and long-term cumulative rates of the combined endpoint were 11%, 17% and 25% in patients treated 12 or fewer hours and 21%, 29% and 37% in patients treated more than 12 hours (P<0.001 for all) after symptom onset. Late presentation was independently associated with an increased risk of an adverse clinical outcome (hazard ratio 1.42, 95% confidence interval 1.22-1.66; P<0.001).
Conclusions:
Increasing duration from symptom onset to primary percutaneous coronary intervention was associated with an increased risk of an adverse clinical outcome in patients with STEMI, especially when the delay exceeded 12 hours.
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