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Percutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI
Frédéric Bouisset1, Edouard Gerbaud2, Vincent Bataille3
1Department of Cardiology, Toulouse Rangueil University Hospital, UMR 1295 INSERM, Toulouse, France.
Insights
Optimal management for late ST-segment elevation myocardial infarction (STEMI) patients remains debated. Revascularization significantly improves outcomes for these patients, reducing mortality in both the short and long term.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Optimal management for ST-segment elevation myocardial infarction (STEMI) presenting >12 hours after symptom onset is debated.
- Late STEMI presentation poses unique challenges for treatment strategies.
- Understanding temporal trends and treatment impacts is crucial for improving patient care.
Purpose of the Study:
- To characterize latecomer STEMI patients.
- To analyze temporal trends in their management.
- To evaluate the impact of revascularization on outcomes in this population.
Main Methods:
- Analysis of 3 nationwide French FAST-MI registry cohorts (2005, 2010, 2015).
- Inclusion of STEMI patients presenting 12-48 hours after symptom onset.
- Comparison of outcomes between revascularized and non-revascularized latecomer patients.
Main Results:
- 18.6% of 6,273 STEMI patients were classified as latecomers.
- Revascularization (n=729) within 48 hours of admission was performed in 67.7% of analyzed latecomers.
- Revascularized latecomers showed significantly lower 30-day (2.1% vs 7.2%) and long-term mortality (HR 0.65).
Conclusions:
- Coronary revascularization is associated with improved short-term outcomes in latecomer STEMI patients.
- Revascularization significantly reduces long-term mortality in this patient group.
- These findings support revascularization as a key strategy for managing late STEMI.
Background:
The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) presenting late->12 hours following symptom onset-is still under debate.
Objectives:
The purpose of this study was to describe characteristics, temporal trends, and impact of revascularization in a large population of latecomer STEMI patients.
Methods:
The authors analyzed the data of 3 nationwide observational studies from the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) program, conducted over a 1-month period in 2005, 2010, and 2015. Patients presenting between 12 and 48 hours after symptom onset were classified as latecomers.
Results:
A total of 6,273 STEMI patients were included in the 3 cohorts, 1,169 (18.6%) of whom were latecomers. After exclusion of patients treated with fibrinolysis and patients deceased within 2 days after admission, 1,077 patients were analyzed, of whom 729 (67.7%) were revascularized within 48 hours after hospital admission. At 30-day follow-up, all-cause death rate was significantly lower among revascularized latecomers (2.1% vs 7.2%; P < 0.001). After a median follow-up of 58 months, the rate of all-cause death was 30.4 (95% CI: 25.7-35.9) per 1,000 patient-years in the revascularized latecomers group vs 78.7 (95% CI: 67.2-92.3) per 1,000 patient-years in the nonrevascularized latecomers group (P < 0.001). In multivariate analysis, revascularization of latecomer STEMI patients was independently associated with a significant reduction of mortality occurrence during follow-up (HR: 0.65 [95% CI: 0.50-0.84]; P = 0.001).
Conclusions:
Coronary revascularization of latecomer STEMI patients is associated with better short and long-term clinical outcomes.
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