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The impact of primary percutaneous coronary intervention timing on prognosis in STEMI patients

Lihui Zhou1, Jin Si2, Ming Yi2

  • 1Department of Geriatrics, Xuanwu Hospital Capital Medical University, National Clinical Research Center for Geriatric Disease, Beijing, China; Department of Cardiology, Beijing Chaoyang Hospital, Capital Medical University, China.

Clinical Medicine (London, England)
|June 6, 2026
PubMed

Insights

Primary percutaneous coronary intervention (PPCI) within 6 hours of ST-segment elevation myocardial infarction (STEMI) symptom onset significantly reduces long-term mortality. PPCI beyond 6 hours may offer in-hospital benefits but does not provide significant long-term advantages compared to no PPCI.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • The efficacy of primary percutaneous coronary intervention (PPCI) for ST-segment elevation myocardial infarction (STEMI) initiated more than 6 hours after symptom onset is not well-established.
  • Timely reperfusion therapy is crucial for improving outcomes in STEMI patients.

Purpose of the Study:

  • To evaluate the long-term clinical outcomes of PPCI performed within 6 hours versus beyond 6 hours after STEMI symptom onset.
  • To compare outcomes of PPCI (both early and delayed) against no reperfusion therapy in STEMI patients.

Main Methods:

  • A retrospective analysis of 3720 STEMI patients from January 2009 to December 2022.
  • Patients were categorized into three groups: PPCI within 6h, PPCI beyond 6h, and no PPCI.
  • Clinical outcomes were assessed using Cox multivariable analyses and propensity score matching.

Main Results:

  • PPCI within 6 hours was associated with significantly lower long-term mortality (HR 0.565, p < 0.001) and Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) (HR 0.765, p = 0.003) compared to no PPCI.
  • PPCI beyond 6 hours showed comparable long-term mortality (HR 0.766, p = 0.068) and MACCE (HR 0.884, p = 0.234) versus no PPCI, despite potentially improved in-hospital outcomes.
  • Propensity score-matched analyses confirmed these findings.

Conclusions:

  • Performing PPCI within 6 hours of STEMI symptom onset is essential for achieving significant long-term survival benefits.
  • While delayed PPCI might offer some in-hospital advantages, it does not translate to improved long-term outcomes compared to conservative management.
Abstract

Keywords:
Long-term outcomePrimary percutaneous coronary interventionST-segment elevation myocardial infarctionTiming

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