Key result
Early PCI (within 7 days) for recent myocardial infarction yielded similar 30-day mortality and long-term major cardiac events compared to late PCI, despite more severe baseline heart failure.
Why the study?
Does early PCI compared to late PCI improve clinical outcomes in patients with recent myocardial infarction presenting more than 24 hours from symptom onset?
Cohort (n=525)
No
Does early PCI compared to late PCI improve clinical outcomes in patients with recent myocardial infarction presenting more than 24 hours from symptom onset?
In patients with recent myocardial infarction presenting >24 hours from symptom onset, clinical outcomes were similar between early (≤7 days) and late (>7 days) PCI, despite early PCI patients having more severe heart failure at presentation.
Draft 1: Suggests PCI timing beyond 24 hours may not independently drive outcomes.
BACKGROUND: The various guidelines clearly mention the treatment strategies for in patient of acute myocardial infarction (MI) presenting more than 24h from symptom onset (recent myocardial infarction, RMI). However, the appropriate timing of reperfusion for RMI is unclear. METHODS: We retrospectively evaluated 525 consecutive MI patients who underwent percutaneous coronary intervention (PCI) in our hospital between January 2008 and December 2012. RESULTS: Sixty RMI patients were more frequently associated with cardiac complications such as myocardial rupture (3.3% vs. 0%; p<0.01), ventricular septal rupture (3.3% vs. 0.4%; p<0.05), and congestive heart failure (15% vs. 2.6%; p<0.001) than 272 consecutive ST-elevation myocardial infarction (STEMI) patients. Of the 60 RMI patients, 33 (55.0%) underwent PCI within 7days (early-PCI group) and 27 (45.0%) underwent PCI after 7days (late-PCI group). Left ventricular ejection fraction measured by echocardiography at second hospital day was similar between the groups. The early-PCI group was more significantly associated with cardiogenic shock and heart failure and more frequently required intra-aortic balloon pumping (24.2% vs. 3.7%; p<0.05) than the late-PCI group. There were no significant differences in 30-day mortality, cardiac complications, and major cardiac events during long-term follow-up (12-36 months) between the groups. CONCLUSION: RMI patients had a higher incidence of cardiac complications than AMI patients. Clinical outcomes were similar between patients undergoing early revascularization and those undergoing late revascularization, although the former group included a higher proportion of patients with severe cardiac failure.
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Mizuguchi et al. (2017) conducted a cohort in recent myocardial infarction (n=525). Early percutaneous coronary intervention (within 7 days) vs. Late percutaneous coronary intervention (after 7 days) was evaluated on 30-day mortality, cardiac complications, and major cardiac events. Early PCI (within 7 days) for recent myocardial infarction yielded similar 30-day mortality and long-term major cardiac events compared to late PCI, despite more severe baseline heart failure.
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