Key result
Late primary percutaneous coronary intervention (beyond 12 hours) may benefit late-presenting STEMI patients, particularly those with haemodynamic instability, ongoing ischaemia, or viable myocardium.
Why the study?
Optimal management for patients with STEMI who arrive at a hospital late remains uncertain due to limited evidence and real-world data.
Does late primary percutaneous coronary intervention (PCI) improve outcomes in patients with ST-segment elevation myocardial infarction (STEMI) presenting beyond 12 hours?
Does late primary percutaneous coronary intervention (PCI) improve outcomes in patients with ST-segment elevation myocardial infarction (STEMI) presenting beyond 12 hours?
Late primary PCI beyond 12 hours may still be beneficial in specific subgroups of STEMI patients, such as those with instability, ongoing ischemia, or viable myocardium.
Optimal management for patients with ST-segment elevation myocardial infarction (STEMI) who arrive at a hospital late remains uncertain since evidence and real-world data are limited. Patients who present late with a STEMI are a heterogeneous population, and the clinical decision regarding percutaneous coronary intervention (PCI) should not be the same for all. One randomized clinical trial, multiple mechanistic studies, and contemporary registries suggest a presumed benefit for a prompt restoration of coronary flow even in late presenting STEMI. Crucial elements in decision-making are the presence of haemodynamic or electrical instability, and ongoing ischaemic signs or symptoms to tip the scales toward PCI. Among clinically stable, late-presenting patients, myocardial viability assessment and functional testing can identify yet another subgroup that may benefit from late PCI.
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Leonardo Bolognese (2021) conducted a review in ST-segment elevation myocardial infarction (STEMI). Late primary percutaneous coronary intervention (PCI) was evaluated. Late primary percutaneous coronary intervention (beyond 12 hours) may benefit late-presenting STEMI patients, particularly those with haemodynamic instability, ongoing ischaemia, or viable myocardium.
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