Does primary percutaneous coronary intervention improve reperfusion success in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared to those presenting <12 hours?
Primary PCI provides substantial myocardial salvage in late-presenting (12-72 hours) STEMI patients with ongoing ischemia, supporting current guideline recommendations despite smaller salvage compared to early presenters.
BACKGROUND: Guidelines recommend primary percutaneous coronary intervention (PCI) in patients with ST-segment-elevation myocardial infarction (STEMI) presenting ≥12 hours of symptom onset in the presence of ongoing ischemia. However, data supporting this recommendation are limited. We evaluated the effect of primary PCI on reperfusion success, using cardiac magnetic resonance, in STEMI patients with signs of ongoing ischemia presenting 12 to 72 hours after symptom onset compared with STEMI patients presenting <12 hours. METHODS AND RESULTS: values <0.05). CONCLUSIONS: STEMI patients with signs of ongoing ischemia treated with primary PCI 12 to 72 hours after symptom onset had less myocardial salvage and developed larger infarcts. However, a large proportion achieved substantial myocardial salvage indicating a benefit from primary PCI in late-presenting patients. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov . Unique identifiers: NCT01435408 and NCT01960933.
Nepper‐Christensen et al. (Sat,) studied this question.