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Article Abstract
Objective: The best time to perform percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients presenting 12 to 72 hours after chest pain is unclear. The aim of this study was to explore whether delayed PCI was superior to emergency PCI in STEMI patients who presented 12 to 72 hours after onset of symptoms and with a spontaneous reperfusion infarct-related artery (IRA).
Methods: STEMI patients who presented 12 to 72 hours after symptom onset were enrolled and assigned to either the emergency PCI or delayed PCI group. We compared the rates of procedural success and in-hospital mortality as well as the main adverse cardiac events (MACE) during hospitalisation and after one year of follow up.
Results: We enrolled 159 patients in this retrospective study. Emergency PCI was performed in 73 patients and delayed PCI in 86 patients. A remarkably high rate of procedural success was achieved in the delayed PCI group compared with the emergency PCI group (97.7 vs 86.3%, p = 0.007) due to a lower rate of no re-flow or slow flow (2.3 vs 13.7%, p = 0.007). There was no significant difference in terms of MACE and in-hospital mortality rates (16.4 vs 9.3%, p = 0.133; 1.4 vs 2.3%, p = 0.562). During one year of follow up, the left ventricular ejection fraction was similar in the two groups [median 58% (57-68) in the emergency PCI group vs median 56% (50-62) in the delayed PCI group, p = 0.666]. Although the emergency PCI group had a trend towards a higher rate of MACE, the difference was not statistically significant (12.2 vs 11.6%, HR = 1.067, 95% CI: 0.434-2.627, p = 0. 887).
Conclusions: In STEMI patients who presented late (12-72 hours) after symptom onset and with a spontaneous reperfusion IRA, delayed PCI showed a higher rate of procedural success without increased rates of in-hospital and long-term MACE and mortality.
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| http://dx.doi.org/10.5830/CVJA-2019-009 | DOI Listing |
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