ST-elevation myocardial infarction late-presenting patients: time for a new paradigm?
Francesco Antonio Veneziano1, Francesca Frecentese2, Raffaella Mistrulli3
1Department of Cardiology, Campus Bio-Medico University, Rome; Department of Cardiology, Ospedali Riuniti Padova Sud, Padua.
Summary
Percutaneous coronary angioplasty (PCI) is crucial for ST-elevation myocardial infarction (STEMI). This review examines late STEMI presenters, exploring how advanced imaging may personalize treatment beyond the traditional 12-hour window.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- ST-elevation myocardial infarction (STEMI) treatment relies heavily on timely percutaneous coronary angioplasty (PCI).
- Traditional guidelines define a 12-hour
- golden window
- for PCI, but recommendations for late presenters are inconsistent.
- Late STEMI presenters face worse outcomes and higher mortality, a trend exacerbated by the COVID-19 pandemic.
Purpose of the Study:
- To review current evidence on managing late STEMI presenters.
- To explore the role of emerging imaging techniques in optimizing treatment strategies for this patient group.
- To discuss the potential for personalized medicine in late STEMI presentation.
Main Methods:
- Review of existing clinical evidence and guidelines.
- Analysis of the impact of emerging imaging modalities on STEMI patient characterization.
- Discussion of potential future clinical applications.
Main Results:
- Late STEMI presentation is associated with poorer prognosis and increased in-hospital mortality.
- Advanced imaging techniques offer new insights into patient stratification and pathological consequences.
- Evidence for routine use of imaging-guided strategies in late presenters is still developing.
Conclusions:
- Personalized management approaches for late STEMI presenters are on the horizon.
- Emerging imaging technologies may significantly transform clinical decision-making for this challenging patient subset.
- Further research is needed to solidify the role of imaging in guiding PCI for late STEMI patients.
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