This review highlights pathophysiological considerations and proposes new indications for primary PCI in STEMI patients presenting 12 to 72 hours after symptom onset.
A high proportion of patients with ST-segment elevation myocardial infarction (STEMI) are evaluated more than 12 h after symptom onset. In this setting, current guidelines suggest that mechanical reperfusion should be considered for patients with clinical and/or electrocardiographic evidence of ongoing ischaemia, re-infarction, cardiogenic shock, haemodynamic instability, or documented ejection fraction less than 40% and serious ventricular arrhythmias. Moreover, some adjunctive aspects like the stuttering course of acute myocardial infarction, the chance of an existing coronary collateral circulation, the ischaemic preconditioning and the infarct-related artery patency should be taken into consideration for patients with STEMI presenting from 12 to 72 h after symptom onset. These patients are known as 'early' latecomers. The aim of the present review is to summarize the current knowledge of the pathophysiology related to this topic and to suggest some new indications for primary percutaneous coronary intervention in 'early' latecomers.
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Fontanelli et al. (2010) studied this question.
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