Clinical outcomes in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary interventions later than 48 h after symptom onset
Authors' conclusion
PCI >12 h after symptom onset was associated with less favourable outcomes, but very late vs. late presenters did not have an excess in events.
Study context
- Population
- STEMI patients undergoing percutaneous coronary intervention (PCI), Bern-PCI registry and Special Program University Medicine ACS (SPUM-ACS), 2009–2019
- Participants
- 6,589 patients
- Exposure
- Late and very late vs early PCI by symptom-to-balloon time
- Outcome
- Co-primary: all-cause mortality and TLF (cardiac death, target vessel MI, target lesion revascularization)
- Follow-up
- 1 year
Methodological detailsmulticentre
- Multicentre
Main finding
As reported in the abstract
Early
- All-cause mortality
- 4.4%
- Target lesion failure (TLF)
- 6.5%
Late
- All-cause mortality
- 5.8%
- TLF
- 8.3%
Very late
- All-cause mortality
- 6.8%
- TLF
- 9.4%
All-cause mortality
Early4.4%
Late5.8%
Very late6.8%
Target lesion failure (TLF)
Early6.5%
Late8.3%
Very late9.4%
Hazard ratio (95% CI)P value
Latevs Earlyall-cause mortality
1.34(1.01–1.78)
P = 0.04Very latevs Earlyall-cause mortality
1.59(1.12–2.25)
P < 0.01Very latevs Lateall-cause mortality
1.18(0.79–1.77)
P = 0.42Latevs EarlyTLF
1.29(1.02–1.63)
P = 0.04Very latevs EarlyTLF
1.47(1.09–1.97)
P = 0.01Very latevs LateTLF
1.14(0.81–1.60)
P = 0.46Observational data: associations, not effects.
Further findings
Drivers of outcomes after adjustment
- HF, impaired renal function and previous gastrointestinal bleeding, but not treatment delay, were the main drivers of outcomes
Original publication
Clinical outcomes in ST-segment elevation myocardial infarction patients undergoing percutaneous coronary interventions later than 48 h after symptom onset. Eur Heart J Acute Cardiovasc Care. Published 30 March 2023. doi:10.
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