Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late-presenting STEMI
Anna C Gonzalez Griffin1, Mehmet Yildiz2, Steven Bradley1
1Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
Insights
Outcomes for ST-elevation myocardial infarction (STEMI) patients presenting 12-24 hours after symptom onset were similar to earlier presenters. Despite unfavorable risk profiles, late STEMI presenters showed comparable in-hospital and 1-year mortality rates.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Previous studies on primary percutaneous coronary intervention (PCI) for late STEMI have yielded inconsistent results.
- Most prior randomized trials were conducted during the fibrinolytic era, predating widespread PCI adoption.
Purpose of the Study:
- To evaluate the characteristics and prognosis of ST-elevation myocardial infarction (STEMI) patients presenting 12-24 hours after symptom onset.
- To assess outcomes in contemporary US regional STEMI systems of care for these late presenters.
Main Methods:
- A two-center registry-based cohort study included 5427 STEMI patients from March 2003 to December 2020.
- Patients were stratified by symptom onset to balloon time: <3, 3-6, 6-12, and 12-24 hours (late presenters).
- Clinical characteristics, revascularization rates, door-to-balloon times, and mortality were analyzed.
Main Results:
- Late presenters (6.2% of cohort, rising to 11% during early COVID-19) were more likely to be older, female, and have hypertension and diabetes.
- Late presenters had longer median door-to-balloon times and were less likely to undergo PCI.
- In-hospital and 1-year mortality risks were similar between late presenters and those presenting within 12 hours.
Conclusions:
- Despite higher risk profiles and delays in treatment, late STEMI presenters had comparable clinical outcomes to earlier presenters.
- Contemporary STEMI systems of care appear to mitigate the negative prognostic impact of delayed presentation.
Objectives:
To assess the characteristics and prognosis of ST-elevation myocardial infarction (STEMI) patients, presenting between 12 and 24 h after symptom onset, in contemporary regional STEMI systems of care in the United States.
Background:
Previous observational studies have been inconsistent regarding the benefit of primary percutaneous coronary intervention (PCI) compared with conservative management for late-presenting STEMI patients and the majority of randomized trials are from the fibrinolytic era.
Methods:
Using a two-center registry-based cohort from March 2003 to December 2020, we evaluated the frequency, clinical characteristics, and outcomes of STEMI patients, stratified by symptom onset to balloon time: <3, 3-6, 6-12, and 12-24 h (late presenters).
Results:
Among 5427 STEMI patients with available symptom onset time, 6.2% were late presenters, which increased to 11% during the early phase of the Covid-19 pandemic. As symptom onset to balloon time increased, patients were more likely to be older, female, and have a history of hypertension and diabetes mellitus. Late presenters with an identifiable culprit lesion were less likely to be revascularized with PCI (96%, 96%, 95%, and 92%; p for trend = 0.004) and had a longer median door-to-balloon time (82, 109, 107, and 117 min; p for trend < 0.001). In-hospital and 1-year death risks were comparable between late and earlier presenters.
Conclusion:
Despite the unfavorable risk profile and longer door-to-balloon time, clinical outcomes of late presenters were similar to those presenting within 12 h of symptom onset.
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