Early versus late delayed percutaneous coronary intervention in elderly patients with ST-segment elevation myocardial
Jiachun Lang1,2, Chen Wang1,2, Jingxia Zhang2
1Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
Insights
For elderly patients with ST-segment elevation myocardial infarction (STEMI), early delayed percutaneous coronary intervention (PCI) within 48 hours is not superior to late PCI after 48 hours. Both early and late delayed PCI show similar long-term clinical outcomes in this patient group.
Area of Science:
- Cardiology
- Geriatric Medicine
- Interventional Cardiology
Background:
- Elderly patients with ST-segment elevation myocardial infarction (STEMI) often miss the optimal 12-hour window for primary percutaneous coronary intervention (PCI).
- The ideal timing for delayed PCI in this demographic remains unclear, necessitating further investigation into early versus late intervention strategies.
Purpose of the Study:
- To compare the clinical outcomes of early (12-48 hours) versus late (48 hours-28 days) delayed PCI in elderly patients (≥65 years) with STEMI.
- To determine if earlier intervention improves long-term outcomes in elderly STEMI patients presenting outside the optimal time window.
Main Methods:
- A cohort of 512 elderly patients with STEMI undergoing delayed PCI after 12 hours from symptom onset was analyzed.
- Patients were categorized into early (12-48h) and late (48h-28d) PCI groups; propensity score matching (PSM) was used to control for confounding factors.
- The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), including all-cause death, cardiac death, recurrent MI, stroke, and revascularization.
Main Results:
- Over a mean follow-up of 77 months, 31.8% of patients experienced MACCE and 18.2% died.
- No significant difference in MACCE or its components was observed between the early and late delayed PCI groups, both before and after PSM.
- Specific outcomes like all-cause death, cardiac death, recurrent MI, stroke, and revascularization were comparable between the two groups.
Conclusions:
- Early delayed PCI (12-48 hours) in elderly STEMI patients presenting after 12 hours is not associated with improved long-term clinical outcomes compared to late delayed PCI (48 hours-28 days).
- The timing of delayed PCI in this population does not significantly impact major adverse cardiac and cerebrovascular events, suggesting flexibility in treatment scheduling.
Background And Objective:
There are a substantial proportion of elderly patients with ST-segment elevation myocardial infarction (STEMI) miss the optimal time window (12 h from symptom onset) of primary percutaneous coronary intervention (PCI). For these patients, the ideal timing of delayed PCI remains undetermined. Therefore, this study compared the clinical outcomes of early versus late delayed PCI in elderly patients with STEMI.
Methods:
From January 2014 to September 2019, 512 patients aged ≥ 65 years with STEMI who underwent delayed PCI after 12 h from symptom onset were included and then categorized into the early PCI group (12-48 h, n = 111) and late PCI group (48 h-28 days, n = 401) according to the timing of delayed PCI. Propensity score matching (PSM) was conducted to adjust the confounding factors between groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction (MI), stroke, and ischemia-driven revascularization.
Results:
During a mean follow-up of 77 months, 163 (31.8%) patients developed MACCE and 93 (18.2%) died. Early or late delayed PCI did not make a significant difference in clinical outcomes of MACCE (Before PSM: HR 0.773, 95% CI 0.520-1.149, P = 0.203; After PSM: HR 0.869, 95% CI 0.498-1.517, P = 0.622), all-cause death, cardiac death, recurrent MI, stroke, and ischemia-driven revascularization in both overall patients and the PSM cohorts.
Conclusion:
Early delayed PCI (12-48 h from symptom onset), for elderly patients with STEMI who present > 12 h after symptom onset is not associated with better long-term clinical outcomes compared with late delayed PCI (48 h-28 days).
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