Percutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI.
J Am Coll Cardiol
; 78(13): 1291-1305, 2021 09 28.
Article
in En
| MEDLINE
| ID: mdl-34556314
ABSTRACT
BACKGROUND:
The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) presenting late->12 hours following symptom onset-is still under debate.OBJECTIVES:
The purpose of this study was to describe characteristics, temporal trends, and impact of revascularization in a large population of latecomer STEMI patients.METHODS:
The authors analyzed the data of 3 nationwide observational studies from the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) program, conducted over a 1-month period in 2005, 2010, and 2015. Patients presenting between 12 and 48 hours after symptom onset were classified as latecomers.RESULTS:
A total of 6,273 STEMI patients were included in the 3 cohorts, 1,169 (18.6%) of whom were latecomers. After exclusion of patients treated with fibrinolysis and patients deceased within 2 days after admission, 1,077 patients were analyzed, of whom 729 (67.7%) were revascularized within 48 hours after hospital admission. At 30-day follow-up, all-cause death rate was significantly lower among revascularized latecomers (2.1% vs 7.2%; P < 0.001). After a median follow-up of 58 months, the rate of all-cause death was 30.4 (95% CI 25.7-35.9) per 1,000 patient-years in the revascularized latecomers group vs 78.7 (95% CI 67.2-92.3) per 1,000 patient-years in the nonrevascularized latecomers group (P < 0.001). In multivariate analysis, revascularization of latecomer STEMI patients was independently associated with a significant reduction of mortality occurrence during follow-up (HR 0.65 [95% CI 0.50-0.84]; P = 0.001).CONCLUSIONS:
Coronary revascularization of latecomer STEMI patients is associated with better short and long-term clinical outcomes.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Registries
/
Time-to-Treatment
/
Percutaneous Coronary Intervention
/
ST Elevation Myocardial Infarction
Type of study:
Observational_studies
Limits:
Aged
/
Female
/
Humans
/
Male
/
Middle aged
Country/Region as subject:
Europa
Language:
En
Journal:
J Am Coll Cardiol
Year:
2021
Document type:
Article
Affiliation country: