Key result
PPCI within 6 hours of STEMI links to ~43% lower cumulative mortality versus no PPCI.
Why the study?
The benefit of primary percutaneous coronary intervention performed beyond 6 hours after STEMI symptom onset remained uncertain.
Does the timing of primary percutaneous coronary intervention (within 6 hours vs beyond 6 hours) improve mortality and MACCE in patients with STEMI compared to no PPCI?
Cohort (n=3,720)
Does the timing of primary percutaneous coronary intervention (within 6 hours vs beyond 6 hours) improve mortality and MACCE in patients with STEMI compared to no PPCI?
Hazard Ratio: 0.565 (95% CI 0.429–0.744)
Absolute Event Rate: 13.1% vs 24%
p-value: p=<0.001
Primary PCI within 6 hours of symptom onset provides significant long-term mortality benefits in STEMI patients, whereas PCI beyond 6 hours does not significantly improve long-term survival compared to no PCI.
May support prioritizing PPCI within 6 hours in STEMI; leaves open benefit of later intervention versus none.
BACKGROUND: The benefit of primary percutaneous coronary intervention (PPCI) performed beyond 6hours after ST-segment elevation myocardial infarction (STEMI) symptom onset remains uncertain. METHODS: Patients presenting with STEMI from January 2009 to December 2022 were consecutively enrolled and stratified into three groups: PPCI within 6h, PPCI beyond 6h, and no PPCI. Clinical outcomes were compared using Cox multivariable analyses and propensity score matching. RESULTS: A total of 3720 patients were included (77.4% male, mean age 62.61 ± 12.66 years). Patients were divided into PPCI within 6h group (n = 1127, 30.3%), PPCI beyond 6h group (n = 587, 15.8%), and no PPCI group (n = 2006, 53.9%). In-hospital mortality rates were 2.8%, 4.1%, and 5.2%, respectively (p = 0.006), with pairwise analysis revealing significant differences among the groups. During a median follow-up of 4.96 years, cumulative mortality was 13.1% in PPCI within 6h group, 16.0% in PPCI beyond 6h group, and 24.0% in no PPCI group (P < 0.001). PPCI within 6h was associated with lower mortality [adjusted hazard ratio (HR) 0.565 (0.429-0.744), p < 0.001] or MACCE [adjusted HR 0.765 (0.640-0.914), p = 0.003], while PPCI beyond 6h showed comparable cumulative mortality [adjusted HR 0.766 (0.575-1.020), p = 0.068] and MACCE [adjusted HR 0.884 (0.721-1.083), p = 0.234] versus no PPCI. Concordant results were observed in propensity score-matched cohorts. CONCLUSION: While PPCI beyond 6hours of symptom onset may improve in-hospital outcomes in STEMI patients, it is necessary to perform PPCI within 6hours to achieve significant long-term benefits.
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Zhou et al. (2026) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=3,720). Primary percutaneous coronary intervention (PPCI) within 6 hours vs. No PPCI was evaluated on Cumulative mortality (HR 0.565, 95% CI 0.429-0.744, p=<0.001). Primary percutaneous coronary intervention within 6 hours of STEMI symptom onset was associated with lower cumulative mortality compared to no PPCI (HR 0.565; 95% CI 0.429-0.744; p<0.001).
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