In STEMI patients presenting ≥12 hours after symptom onset, revascularization was independently associated with reduced long-term mortality (HR 0.56; 95% CI 0.34-0.91; p=0.02).
Cohort (n=2,206)
Does late presentation or revascularization impact short and long-term mortality in patients with STEMI?
Revascularization of the culprit lesion in STEMI patients presenting late (≥12 hours) is associated with significantly reduced in-hospital and long-term mortality, supporting an invasive strategy regardless of presentation time.
Hazard Ratio: 0.56 (95% CI 0.34–0.91)
p-value: p=0.02
Abstract Background Characteristics and outcomes of a real-world population of latecomers (12 to 48h after symptom onset) and very-latecomers (≥48 h) with ST-segment elevation myocardial infarction (STEMI) are still poorly explored. Moreover, the optimal management of these patients remains controversial. Objectives The aim of this study is to investigate characteristics and outcomes of latecomer and very-latecomers STEMI patients. Methods Of 5350 patients with acute myocardial infarction (AMI) diagnosis from the AMIPE Registry, 2206 consecutive patients diagnosed with STEMI between January 2017 and December 2023 were categorized as latecomers (12 to 48 h; n=279), very- latecomers (≥48 h; n=209) or earlycomers (12 h; n =1720). The main outcomes were in-hospital mortality and long-term all-cause mortality. Results Latecomers and very-latecomers had a higher rate of in-hospital mortality (p0.001) and all-cause death during a median follow-up of 32 months (p0.001), whereas presentation ≥12 hours after symptom onset was not independently associated with increased in-hospital or long-term mortality. The use of invasive approach decreased between groups (87.5% in latecomers and 75.8% in very-latecomers vs 99.3% of earlycomers, p0.001) and presentation ≥12 hours was identified as a strong independent predictor of non-invasive strategy (OR 21.39; CI 9.19-49.7; p0.001). In multivariate analysis, revascularization of latecomers was independently associated with a significant reduction of in-hospital mortality (OR: 0.47; CI 0.24-0.94; p=0.03) and long-term mortality during follow-up (HR: 0.56; CI 0.34-0.91; p=0.02). Conclusions In our cohort, latecomers had worse short and long-term outcomes compared to earlycomers, whereas presentation ≥12 hours was not independently associated with increased mortality. However, revascularization of the culprit lesion in all latecomers was independently associated with reduced in-hospital and long-term mortality. This finding underscores the impact of invasive strategies in this population that necessitate a more comprehensive and individualized approach, irrespective of the time of presentation.K-M Mortality K-M MACE
Manaresi et al. (Sat,) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=2,206). Revascularization vs. No revascularization was evaluated on long-term mortality (HR 0.56, 95% CI 0.34-0.91, p=0.02). In STEMI patients presenting ≥12 hours after symptom onset, revascularization was independently associated with reduced long-term mortality (HR 0.56; 95% CI 0.34-0.91; p=0.02).