Optimal timing of percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial
Haiyan Jia1,2, Weifeng Zhang1,2, Shengqi Jia3
1Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, China.
Insights
For elderly patients with acute ST-segment elevation myocardial infarction (STEMI) who missed the optimal treatment window, immediate percutaneous coronary intervention (PCI) did not improve long-term outcomes. Delayed PCI strategies showed reduced heart failure-related hospitalizations compared to immediate PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
- Geriatric Cardiology
Background:
- Primary percutaneous coronary intervention (PPCI) is standard for acute ST-segment elevation myocardial infarction (STEMI).
- Optimal management for STEMI patients presenting outside the ideal time window remains debated.
- Elderly patients may have different responses to reperfusion strategies.
Purpose of the Study:
- To compare the long-term prognosis of elderly STEMI patients treated with percutaneous coronary intervention (PCI) at different time intervals after symptom onset (>12 hours).
- To evaluate the impact of immediate versus delayed PCI on major adverse cardiac events and heart failure hospitalizations.
Main Methods:
- A randomized study of 320 elderly STEMI patients presenting >12 hours after symptom onset.
- Patients were divided into four groups based on PCI timing: immediate (<24h), early (24-72h), delayed (72-168h), and late (≥168h).
- Primary endpoints included 12-month cardiac mortality, nonfatal MI, target-vessel revascularization, and heart failure rehospitalization.
Main Results:
- No significant differences were observed in cardiac mortality, nonfatal myocardial infarction (MI), or target-vessel revascularization among the groups.
- Heart failure-related rehospitalization was significantly higher in the immediate PCI group (18.8%) compared to early (5.1%), delayed (7.4%), and late (6.3%) PCI groups.
- Delayed PCI strategies (early, delayed, late) were associated with significantly lower heart failure-related rehospitalizations compared to immediate PCI.
Conclusions:
- Immediate PCI in elderly STEMI patients presenting >12 hours after symptom onset does not reduce adverse clinical outcomes.
- Delayed percutaneous coronary intervention strategies may be preferable in this patient population to reduce heart failure-related hospitalizations.
- Further research is warranted to optimize reperfusion strategies for late-presenting STEMI patients.
Introduction:
Primary percutaneous coronary intervention (PPCI) is an effective method for the clinical treatment of acute ST-segment elevation myocardial infarction (STEMI). For patients who miss the optimal time window, optimal management of these patients remains controversial.
Aim:
To compare the effects of different timing of percutaneous coronary intervention on the long-term prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) with time from symptom onset > 12 hours.
Material And Methods:
Elderly acute STEMI patients with time from symptom onset > 12 hours in the period from July 2021 to July 2022 in the Department of Cardiology, Affiliated Hospital of Hebei University, were randomly divided into four groups: group 1 (immediate invasive strategy, percutaneous coronary interventions (PCI) < 24 hours after symptoms onset, n = 80), group 2 (early invasive strategy, 24-< 72 hours after symptoms onset, n = 80), group 3 (delayed invasive strategy after symptoms onset, 72-< 168 hours after symptoms onset, n = 80), and group 4 (late PCI group after symptoms onset, ≥ 168 hours after symptoms onset, n = 80). Primary study end points were 12-month cardiac mortality, nonfatal myocardial infarction (MI), target-vessel revascularization, and heart failure-related rehospitalization.
Results:
There were no significant differences between groups in cardiac mortality, nonfatal MI and target-vessel revascularization. During follow-up, heart failure-related rehospitalization was higher in group 1 than in the other groups (18.8% vs. 5.1% vs. 7.4% vs. 6.3%, p = 0.010). Compared with group 1, group 2, group 3 and group 4 had lower heart failure-related rehospitalization (HR = 0.250, 95% CI: 0.083-0.753, p = 0.014) (HR = 0.377, 95% CI: 0.146-0.971, p = 0.043) (HR = 0.320, 95% CI: 0.116-0.879, p = 0.027).
Conclusions:
For acute STEMI patients who missed the optimal time of PCI, immediate PCI did not reduce adverse clinical outcomes.
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