Clinical Characteristics and Outcomes Stratified by Time to ST-Segment Elevation Myocardial Infarction Presentation
Yosuke Kakimoto1, Ko Yamamoto2, Masahiro Natsuaki3
1Cardiovascular Center, Saga Medical Center, Koseikan, Saga, Japan.
Insights
Late presentation of ST-segment elevation myocardial infarction (STEMI) is linked to specific patient demographics and symptom timing. Targeted interventions are needed to reduce delays in STEMI treatment for high-risk groups.
Area of Science:
- Cardiology
- Acute Coronary Syndromes
- Public Health
Background:
- Limited data exists on clinical characteristics of ST-segment elevation myocardial infarction (STEMI) patients experiencing delayed hospital presentation.
- Understanding factors associated with delayed STEMI care is crucial for improving patient outcomes.
Purpose of the Study:
- To compare baseline characteristics and clinical outcomes of early versus late presenters with STEMI undergoing percutaneous coronary intervention (PCI).
- To identify factors independently associated with late presentation in STEMI patients.
Main Methods:
- Analysis of 719 consecutive STEMI patients who underwent PCI, categorized by symptom onset to door time (<2.3 hours for early, ≥2.3 hours for late).
- Comparison of demographic, clinical data, and procedural outcomes between early and late presentation groups.
- Multivariable analysis to determine independent predictors of late STEMI presentation.
Main Results:
- Late presenters (≥2.3 hours) were independently associated with late night to early morning symptom onset (OR, 2.03), age ≥75 years (OR, 1.56), and female sex (OR, 1.49).
- Culprit lesions in the right coronary artery (RCA) were inversely associated with late presentation (OR, 0.62).
- Door to balloon times were similar between groups; however, a trend towards higher 3-year all-cause mortality was observed in late presenters (16.3% vs 11.6%).
Conclusions:
- Late STEMI presentation is significantly associated with specific patient profiles including older age, female sex, and symptom onset during nighttime/early morning hours.
- Non-RCA culprit lesions are linked to earlier presentation.
- Developing targeted strategies to reduce symptom onset to door time is essential, particularly for high-risk patient groups.
Abstract:
There were few data on the clinical characteristics of ST-segment elevation myocardial infarction (STEMI) patients with late presentation (long symptom onset to door [hospital arrival] time). Among 719 consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) in the SAGA-ACS registry, we compared baseline characteristics and clinical outcomes between patients with early presentation (symptom onset to door time <2.3 hours) and late presentation (≥2.3 hours). The cut-off point of 2.3 hours was the median value for the present study population. The median onset to door time was 1.3 hours in the early presentation group, and 4.8 hours in the late presentation group. Door to balloon time was not different between the groups (62.0 minutes vs 60.5 minutes). Late night to early morning onset (OR, 2.03; 95% CI, 1.45 to 2.85), age ≥75 years (OR, 1.56; 95% CI, 1.09 to 2.22), and women (OR, 1.49; 95% CI, 1.03 to 2.16) were independently associated with the late presentation, while culprit lesions in right coronary artery (RCA) was inversely associated the late presentation (OR, 0.62; 95% CI, 0.46 to 0.85). During the median 2.7 years follow-up, the cumulative incidence of all-cause death was numerically, but not statistically, higher in the late presentation group than in the early presentation group (16.3% vs 11.6% at 3 years, HR, 1.42; 95% CI, 0.97 to 2.07; p = 0.07). In conclusion, among patients with STEMI who underwent PCI, late night to early morning onset, advanced age, women, and culprit lesions in non-RCA were strongly associated with the late presentation. Strategies for minimizing symptom onset to door time should be targeted especially in these patients.
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