Key result
Late percutaneous coronary intervention in STEMI patients was associated with a lower risk of major adverse cardiovascular events compared to medical therapy alone (HR 0.507; 95% CI 0.412-0.625; P<0.001).
Why the study?
The optimal strategy for treating late presenters of STEMI remains uncertain.
Does late percutaneous coronary intervention prevent left ventricular remodeling and improve clinical outcomes in late presenters of STEMI compared to standard medical therapy alone?
Cohort (n=1,090)
Yes
Does late percutaneous coronary intervention prevent left ventricular remodeling and improve clinical outcomes in late presenters of STEMI compared to standard medical therapy alone?
Hazard Ratio: 0.507 (95% CI 0.412–0.625)
p-value: p=< 0.001
Late PCI in STEMI patients presenting late is associated with reduced left ventricular remodeling and improved long-term clinical outcomes, including reduced MACE and mortality.
Late PCI was associated with less remodeling and fewer events in late STEMI; hypothesis-generating, does not support practice change.
BACKGROUND: The optimal strategy for treating late presenters of ST-elevation myocardial infarction (STEMI) remains uncertain. HYPOTHESIS: percutaneous coronary intervention (PCI) has a favorable effect on left ventricular (LV) remodeling and clinical outcomes in late presenters of STEMI. METHODS: Patients with STEMI who were hospitalized between 2009 and 2011 at 7 PCI-capable hospitals in China were selected. Cardiac characteristics were reassessed by echocardiography between August 2013 and January 2014. The clinical endpoints were evaluated during a median follow-up period of 36 months. RESULTS: 1090 patients who either underwent late PCI (n = 786) or received standard medical therapy alone (n = 304) was analyzed. Left ventricular remodeling was more pronounced in the conservative-treatment group. Logistic regression revealed that late PCI was independently and negatively correlated with LV remodeling (odds ratio: 0.356, 95% confidence interval [CI]: 0.251-0.505, P < 0.001). Kaplan-Meier analysis showed the lower risks of major adverse cardiovascular events (MACE), all-cause death, and rehospitalization for heart failure in the late-PCI group. Multivariate Cox regression revealed that late PCI was significantly associated with lower risks for MACE, all-cause death, and rehospitalization for heart failure both in all patients (hazard ratio [HR]: 0.507, 95% CI: 0.412-0.625, P < 0.001; HR: 0.419, 95% CI: 0.314-0.559, P < 0.001; and HR: 0.583, 95% CI: 0.379-0.896, P = 0.014, respectively) and in the matched patients (HR: 0.466, 95% CI: 0.358-0.607, P < 0.001; HR: 0.398, 95% CI: 0.277-0.571, P < 0.001; and HR: 0.498, 95% CI: 0.283-0.878, P = 0.016, respectively) by propensity-score analysis. CONCLUSIONS: Late-PCI strategy prevents LV remodeling and improves clinical outcomes in STEMI patients compared with conservative strategies.
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Fan et al. (2015) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=1,090). Late percutaneous coronary intervention (PCI) vs. Standard medical therapy alone was evaluated on Major adverse cardiovascular events (MACE) (HR 0.507, 95% CI 0.412-0.625, p=< 0.001). Late percutaneous coronary intervention in STEMI patients was associated with a lower risk of major adverse cardiovascular events compared to medical therapy alone (HR 0.507; 95% CI 0.412-0.625; P<0.001).
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