Key result
Delayed percutaneous coronary intervention significantly reduced the incidence of major adverse cardiac events during hospitalization compared to standard medical therapy in STEMI patients who missed the optimal reperfusion window (MED vs PCI OR 3.074).
Why the study?
Management of STEMI patients who miss the early reperfusion window remains controversial, leaving an open question regarding whether late PCI outperforms standard drug therapy.
Does delayed percutaneous coronary intervention reduce major adverse cardiac events during hospitalization in STEMI patients who miss the optimal treatment window compared to standard medical therapy?
Cohort (n=417)
No
Does delayed percutaneous coronary intervention reduce major adverse cardiac events during hospitalization in STEMI patients who miss the optimal treatment window compared to standard medical therapy?
Odds Ratio: 3.074 (95% CI 1.116–8.469)
p-value: p=0.03
In STEMI patients presenting beyond the optimal 12-hour window, delayed PCI significantly reduces in-hospital MACEs and cardiac death compared to conservative medical therapy.
May support delayed PCI in late STEMI; hypothesis-generating and requires randomized confirmation.
BACKGROUND: Early reperfusion of the coronary artery has become the first choice for patients with ST-segment elevation myocardial infarction (STEMI). How to deal with patients who miss the time window for early reperfusion is still controversial. Based on real-world data, this study was conducted to explore whether percutaneous coronary intervention (PCI) has an advantage over standard drug therapy in patients who miss the optimal treatment window. METHODS: Consecutive patients who were diagnosed with STEMI and met the inclusion criteria between 2009 and 2018 in our center were retrospectively included in this cohort study. The primary endpoint events were major adverse cardiac events (MACEs), including heart failure, sudden cardiac death, malignant arrhythmia, thrombi and bleeding events during the period of admission. Secondary endpoint events were components of MACEs. At the same time, we also evaluated angina pectoris at admission and discharge through Canadian Cardiovascular Society (CCS) grading. RESULTS: This study enrolled 417 STEMI patients and divided them into four groups (PCI < 3 days, 14.87%; 3 days<PCI < 7 days, 21.104%; PCI > 7 days, 34.29%; MED, 29.74%). During the period of admission, MACEs occurred in 52 cases. The incidence of MACEs was 11.29, 7.95, 4.20 and 25.81% in the four respective groups (p < 0.0001). The MED group had higher rates of MACEs (OR = 3.074; 95% CI 0.1.116-8.469, p = 0.03) and cardiac death (OR = 3.027; 95% CI 1.121-8.169, p = 0.029) compared to the PCI group. Although both treatments were effective in improving CCS grade at discharge, the PCI group improved more significantly (p < 0.0001). CONCLUSIONS: In the real world, delayed PCI can be more effective in patients with angina symptoms at discharge and reduce the incidence of MACEs and cardiac death during hospitalization. The timing of intervention was independent of the occurrence of MACEs during hospitalization and of improvement in symptoms.
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Guo et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=417). Percutaneous coronary intervention (PCI) vs. Standard drug therapy (MED) was evaluated on Major adverse cardiac events (MACEs) during hospitalization (OR 3.074, 95% CI 1.116-8.469, p=0.03). Delayed percutaneous coronary intervention significantly reduced the incidence of major adverse cardiac events during hospitalization compared to standard medical therapy in STEMI patients who missed the optimal reperfusion window (MED vs PCI OR 3.074).
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