Invasive reperfusion after 12 hours of the symptom onset remains beneficial in patients with ST-segment elevation myocardial infarction: Evidence from a meta-analysis of published data

Huang, Yang; Xiu, Wen-Juan; Zheng, Ying‐Ying; Liu, Fen; Gao, Ying; Ma, Xiang; Yang, Yi‐Ning; Li, Xiaomei; Ma, Yun; Xie, Xiang

doi:10.5603/cj.a2018.0034

Cited by 16 publications

(7 citation statements)

References 31 publications

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“…When not possible early reperfunsion, late reperfusion should be considered. Late reperfusion has been shown, in some recent studies, to benefit ischemic symptomatic patients reperfused more than 12 h after the onset of myocardial infarction (Ibanez et al, 2018; Nepper-Christensen et al, 2018; Yang et al, 2018). In infarcted patients without symptoms of residual myocardial ischemia there is no clear evidence of late reperfusion benefits.…”

Section: Discussionmentioning

confidence: 99%

Delayed Reperfusion—Coronary Artery Reperfusion Close to Complete Myocardial Necrosis Benefits Remote Myocardium and Is Enhanced by Exercise

et al. 2019

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The present study aimed to analyze the effects of reperfusion of a distant coronary artery on cardiac function, the ultrastructure, and the molecular environment of the remote myocardium immediately after the completion of myocardial regional necrosis: delayed reperfusion (DR). Additionally, the effects of prior exercise on the outcomes of DR were investigated. Female rats with permanent occlusion or delayed reperfusion were randomly assigned to an exercise (swimming, 1 h/day, 5 days/week for 8 weeks) or sedentary protocol. Thus, the study included the following four groups: sedentary permanent occlusion, exercise permanent occlusion, sedentary delayed reperfusion, and exercise delayed reperfusion. The descending coronary artery was occluded for 1 h. Reperfusion was confirmed by contrast echocardiography, and the rats were observed for 4 weeks. Permanent occlusion and DR caused similar myocardial infarction sizes among the four groups. Interestingly, exercise significantly decreased the mortality rate. Delayed reperfusion resulted in significant benefits, including enhanced hemodynamics and papillary muscle contraction, as well as reduced apoptosis and collagen content. Protein calcium kinetics did not change. Meanwhile, developed tension and the Frank–Starling mechanism were enhanced, suggesting that calcium sensitivity was intensified in myofilaments. Remarkable remote myocardial benefits occurred after distant DR, and prior exercise intensified cardiac recovery. Our findings provide valuable information about DR. Our data might explain the better clinical outcomes in recent studies showing that late reperfusion could improve heart failure in patients with myocardial infarction. In conclusion, DR has remote myocardial benefits, including inotropism enhancement, pulmonary congestion reduction, and collagen and apoptosis attenuation, which are enhanced by prior exercise.

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Section: Discussionmentioning

confidence: 99%

Delayed Reperfusion—Coronary Artery Reperfusion Close to Complete Myocardial Necrosis Benefits Remote Myocardium and Is Enhanced by Exercise

et al. 2019

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“…При этом позднее ЧКВ статистически значимо улучшало исходы только в случае, если выполнялось в период 12-48 ч от начала симптомов ишемии, в то время как проведение реваскуляризации в более поздние сроки (2-60 сут.) не оказывало положительного влияния [12].…”

Section: ссылки найденные в информационных системахunclassified

Optimal management of patients with ST-segment elevation myocardial infarction with delayed admission to the percutaneous coronary intervention center (more than 12 hours)

et al. 2021

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The success of myocardial infarction (MI) treatment largely depends on the timely delivery of quality health care, primarily on the blood flow restoration through the infarct-related artery. This review presents the results of several meta-analyzes and studies, including our own data, which indicate that delayed revascularization (>12 h from the onset) performed in patients with ST-segment elevation MI leads to an increase in the short- and long-term survival, a decrease in the incidence of cardiovascular events and severity of myocardial remodeling. For example, the analysis from the V. P. Polyakov Samara Regional Clinical Cardiological Dispensary showed the higher mortality rate in patients with ST-segment elevation MI admitted >12 hours from the onset, who received conservative treatment (7,9%) than in those with the invasive management (0,5%) (hazard ratio, 14,8; 95% confidence interval, 1,7- 124,7; P<0,05). However, at present, there is no complete clarity regarding the strategy of managing such patients. According to the current European Society of Cardiology guidelines on myocardial revascularization (2018), the class of recommendations reaches IIA, which means the conflicting data and/ or disagreement about usefulness/efficacy of a particular treatment method, but weight of evidence/opinion is in favor of usefulness/efficacy.

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“…Ovi rezultati su saglasni sa onima iz naše studije, iako je definicija kasnih prezentera bila drugačija. U različitim meta analizama (Ioannidis [9]; Abbate [10]; Yang [11]), na različitom broju ispitanika, su kasnim prezenterima smatrani STEMI pacijenti, koji su se javili u bolnicu u periodu od 1-45 dana (Ioannidis i sar.) ili 12h-60dana (Abbate i sar.…”

Section: Diskusijaunclassified

Treatment outcome in patients with acute ST elevation myocardial infarction where more than 12 hours and less than 48 hours have passed from the onset of symptoms

Ivanović¹,

Grgur²,

Dabović³

et al. 2020

Halo 194

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Introduction/Objective Patients who have had symptoms for more than 12h before receiving treatment are considered to be myocardial infarction late presenters. The literature contains scarce and often controversial data about treating such patients. The objective of the paper is to present treatment outcome in patients with acute ST-elevation myocardial infarction (STEMI), whose therapy was initiated more than 12h and less than 48 hours after the onset of symptoms. Methods the research included 130 patients who had suffered from acute STEMI in 2017, all of whom presented more than 12h and less than 48h after the onset of symptoms. A primary percutaneous coronary intervention (PPCI) was used to treat 109 patients, while 21 patients were treated conservatively. An analysis was performed correlating treatment results, intrahospital mortality, one-year survival rate depending on the type of treatment, risk factors and comorbidity. Results A statistically significant difference (x 2 =7,119; p=0,017) has been verified when comparing the mortality of STEMI patients treated with PPCI(8.3%) and those treated conservatively (28.6%). A statistically significant difference (t=9,385; p=0,005) has been verified when it came to treating STEMI patients that were also suffering from diabetes. In the group treated with PPCI, 77.8% of the patients that had died had diabetes. No comorbidity showed a statistically significant difference in distribution depending on the type of treatment and treatment results. Conclusion When deciding on the type of treatment these patients shall receive, the following should be taken into consideration: clinical presentation, hemodynamic status and presence of life-threatening arrhythmias. There is still no clear guideline for treating such patients.

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Invasive reperfusion after 12 hours of the symptom onset remains beneficial in patients with ST-segment elevation myocardial infarction: Evidence from a meta-analysis of published data

Abstract: Background: Early myocardial reperfusion therapy (< 12 h) in patients with acute

Cited by 16 publications

References 31 publications

Delayed Reperfusion—Coronary Artery Reperfusion Close to Complete Myocardial Necrosis Benefits Remote Myocardium and Is Enhanced by Exercise

Delayed Reperfusion—Coronary Artery Reperfusion Close to Complete Myocardial Necrosis Benefits Remote Myocardium and Is Enhanced by Exercise

Optimal management of patients with ST-segment elevation myocardial infarction with delayed admission to the percutaneous coronary intervention center (more than 12 hours)

Treatment outcome in patients with acute ST elevation myocardial infarction where more than 12 hours and less than 48 hours have passed from the onset of symptoms

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