Coronary revascularization provides significant value as a treatment option when STEMI patients present late after symptom onset, according to new data published in the Journal of the American College of Cardiology.
Guidelines developed by the American College of Cardiology and American Heart Association, the authors explained, suggest that percutaneous coronary intervention (PCI) is a reasonable choice when STEMI patients present 12-24 hours after symptom onset with clinical or imaging evidence of ongoing ischemia. However, what if it’s been 48 hours or there is no evidence of ongoing ischemia?
The study’s authors aimed to find out, tracking data from three different French registries. The patient data was first obtained in 2005, 2010 and 2015.
Nearly 68% of the study’s 1,077 patients were revascularized within 48 hours of admission. Also, the percentage of latecomer patients decreased from 22.7% in 2005 to 16.1% in 2015.
After 30 days, the authors found, all-cause mortality was 2.1% among patients who underwent PCI and 7.2% among patients who did not. Also, after a median follow-up period of 58 months, all-cause mortality was 30.4 per 1,000 patient-years among patients who underwent PCI and 78.7 per 1,000 patient-years among patients who did not. Revascularization, the group concluded through a multivariate analysis, was “independently associated with a significant reduction of mortality occurrence during follow-up.”
“Although the relative proportion of latecomer STEMI patients decreased over the 10-year period of this study, they still constitute a significant proportion of STEMI patients who are more likely to present comorbidities and atypical presentation,” wrote first author Frédéric Bouisset, MD, a cardiologist at Toulouse Rangueil University Hospital in France, and colleagues. “Coronary revascularization of the infarct artery of latecomer STEMI patients admitted before 48 hours after symptom onset is associated with better long-term clinical outcomes on hard endpoints.”
Click here to read the team’s full analysis.
Michael has more than 16 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.