eISSN: 1897-4252
ISSN: 1731-5530
Kardiochirurgia i Torakochirurgia Polska/Polish Journal of Thoracic and Cardiovascular Surgery
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3/2024
vol. 21
 
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abstract:
Original paper

Optimal timing of percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction presenting late

Haiyan Jia
1, 2
,
Weifeng Zhang
1, 2
,
Shengqi Jia
3
,
Jun Zhang
2
,
Zhanwen Xu
1
,
Yaqin Li
1

  1. Department of Cardiology, Affiliated Hospital of Hebei University, Baoding, China
  2. Department of Cardiology, Cangzhou Central Hospital, Tianjin Medical University, Tianjin, China
  3. Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang, China
Kardiochirurgia i Torakochirurgia Polska 2024; 21 (3): 143-152
DOI: https://doi.org/10.5114/kitp.2024.143685
Online publish date: 2024/09/30
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Introduction
Primary percutaneous coronary intervention (PPCI) is an effective method for the clinical treatment of acute ST-segment elevation myocardial infarction (STEMI). For patients who miss the optimal time window, optimal management of these patients remains controversial.

Aim
To compare the effects of different timing of percutaneous coronary intervention on the long-term prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) with time from symptom onset > 12 hours.

Material and methods
Elderly acute STEMI patients with time from symptom onset > 12 hours in the period from July 2021 to July 2022 in the Department of Cardiology, Affiliated Hospital of Hebei University, were randomly divided into four groups: group 1 (immediate invasive strategy, percutaneous coronary interventions (PCI) < 24 hours after symptoms onset, n = 80), group 2 (early invasive strategy, 24–< 72 hours after symptoms onset, n = 80), group 3 (delayed invasive strategy after symptoms onset, 72–< 168 hours after symptoms onset, n = 80), and group 4 (late PCI group after symptoms onset, ≥ 168 hours after symptoms onset, n = 80). Primary study end points were 12-month cardiac mortality, nonfatal myocardial infarction (MI), target-vessel revascularization, and heart failure-related rehospitalization.

Results
There were no significant differences between groups in cardiac mortality, nonfatal MI and target-vessel revascularization. During follow-up, heart failure-related rehospitalization was higher in group 1 than in the other groups (18.8% vs. 5.1% vs. 7.4% vs. 6.3%, p = 0.010). Compared with group 1, group 2, group 3 and group 4 had lower heart failure-related rehospitalization (HR = 0.250, 95% CI: 0.083–0.753, p = 0.014) (HR = 0.377, 95% CI: 0.146–0.971, p = 0.043) (HR = 0.320, 95% CI: 0.116–0.879, p = 0.027).

Conclusions
For acute STEMI patients who missed the optimal time of PCI, immediate PCI did not reduce adverse clinical outcomes.

keywords:

acute ST segment elevated myocardial infarction, different timing of percutaneous coronary intervention, cardiac mortality, heart failure-related rehospitalization
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