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Comparison of Percutaneous Coronary Intervention Procedures and Outcomes for Recent and Acute ST-Elevation Myocardial

Yusuke Hosokawa1,2, Takeshi Yamamoto1, Shuhei Tara1

  • 1Division of Cardiovascular Intensive Care, Nippon Medical School Hospital.

International Heart Journal
|May 31, 2023
PubMed

Insights

Percutaneous coronary intervention (PCI) for recent ST-elevation myocardial infarction (STEMI) with a totally occluded infarct-related artery (IRA) is safe and effective. Outcomes, including in-hospital mortality, were comparable to acute STEMI cases, despite requiring more complex PCI techniques.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Primary percutaneous coronary intervention (PCI) is standard for acute ST-elevation myocardial infarction (STEMI).
  • Guidelines do not typically recommend PCI for recent STEMI with a totally occluded infarct-related artery (IRA).
  • PCI is permitted in Japan for recent STEMI, but outcomes data are limited.

Purpose of the Study:

  • To investigate the procedural details and outcomes of PCI in recent STEMI patients with a totally occluded IRA.
  • To compare these findings with outcomes in acute STEMI patients undergoing PCI.

Main Methods:

  • Retrospective analysis of 250 STEMI patients treated with PCI for a totally occluded IRA.
  • Patients categorized into recent-STEMI (n=32) and acute-STEMI (n=218) groups based on symptom onset to diagnosis time.
  • Comparison of demographics, procedural characteristics, and short-term outcomes.

Main Results:

  • No significant differences in patient demographics, MI severity, or IRA distribution between groups.
  • PCI procedures in recent STEMI involved more complex techniques (e.g., guidewires, microcatheters, thrombus aspiration).
  • Similar rates of Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 post-PCI and low procedure-related complications in both groups.
  • In-hospital mortality was 0% for recent STEMI versus 4.6% for acute STEMI (P > 0.05).

Conclusions:

  • Recent STEMI with a totally occluded IRA requires more complex PCI techniques.
  • PCI in recent STEMI demonstrates comparable safety, success rates, and in-hospital mortality to acute STEMI.
  • These findings support the consideration of PCI in select recent STEMI cases.

Keywords:
Complicated PCIGuidewireLate reperfusionSafelyTotally occluded thrombotic lesions

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