Long-term outcomes of delayed percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction

Abstract

The best time window of percutaneous coronary intervention (PCI) is within 12 hours for ST-segment elevation myocardial infarction (STEMI). However, there is limited evidence about the proper time of PCI for delayed STEMI patients.From June 2014 to June 2015, a total of 268 patients receiving PCI with second-generation drug-eluting stent in a Chinese hospital after 3 days of STEMI onset were enrolled in this retrospective study, who were divided into the early group (3-14 days) and the late group (>14 days). A propensity score match was conducted to reduce the baseline difference. The primary endpoint of all-cause death and secondary endpoints of major adverse cardiac and cerebrovascular event (myocardial infarction [MI], stroke, emergent revascularization, and rehospitalization due to heart failure) were compared using survival analysis.At last, 182 cases were matched after propensity score match, with no statistical difference in baseline characteristics and PCI data. Kaplan-Meier survival curve demonstrated no difference in all-cause death of the 2 groups (P = .512). However, the early group presented a higher incidence of MI than the late group (P = .036). The multivariate Cox regression analysis also demonstrated that the early PCI was an independent risk factor for MI compared with late PCI (hazard ratio = 3.83, ], P = .001). There was no statistical difference in other major adverse cardiac and cerebrovascular event, including stroke, emergent revascularization, and rehospitalization due to heart failure.Using the 2 nd drug-eluting stent, early PCI (3-14 days) and late PCI (>14 days) have comparable efficacy and outcomes. However, patients receiving early PCI are subjected to a relatively higher risk of recurrent MI.Abbreviations: CAD = coronary artery disease, DES = drug-eluting stent, HR = hazard ratio, MACCE = major adverse cardiac and cerebrovascular event, MI = myocardial infarction, PCI = percutaneous coronary intervention, PSM = propensity score match, STEMI = ST-segment elevation myocardial infarction.

Symptom-to-balloon time and risk of ventricular arrhythmias in patients with STEMI undergoing percutaneous coronary intervention: The VERY-STEMI study

“…However, Li et al found that in patients with STEMI 12–72 h after symptom onset and with spontaneous reperfusion of the infarct-related artery, delayed PCI showed a higher procedural success rate without increasing in-hospital and long-term mortality [ 23 ]. A propensity matched study revealed that patients with STEMI who underwent early PCI (defined in the study as 3-14d after onset) had a higher risk of recurrent MI than patients with STEMI who underwent late PCI (defined in the study as more than 14d after onset) [ 24 ]. The Occluded Artery Trial (OAT) study also showed that in patients with occlusion of the infarct-related artery 3-28d after MI and high-risk criterion, routine PCI did not reduce the incidence of death, reinfarction, or heart failure, and there was a trend toward excess reinfarction compared with optimal medical therapy alone [ 25 ], and this result was not affected by patient risk level or extended follow-up [ 26 , 27 ].…”

Clinical characteristics and outcome of percutaneous coronary intervention in Yemeni patients

“…[ 18 ] However, another study found similar efficacy and long-term outcome in early PCI (3–14 days) and late PCI (>14 days) using a second drug-eluting stent. [ 19 ] Therefore, late PCI is considered in our patients without documented follow-up to assess the long-term outcome. Latecomers post-MI with total occlusion in the coronary angiogram were treated by PCI as a treatment strategy in our center.…”