Long term outcomes for primary percutaneous coronary intervention in late-presentation ST-elevation myocardial infarction.

Abstract

Background: Patients with late-presentation ST-elevation myocardial infarction (STEMI) (12–48 hours of symptom onset) tend to have worse clinical outcomes compared to early presenters (<12 hours of symptom onset). The decision for primary percutaneous coronary intervention (PPCI) is limited by the current evidence, particularly in the modern revascularisation era. Method: Data from 4,265 consecutive patients undergoing PPCI for STEMI within 48 hours of presentation were analysed from the Melbourne Interventional Group registry between 2014 and 2020. There were 4,044 patients in the early presentation (<12 hours) and 221 in the late presentation group (12–48 hours) with mean age 63.3 years (+/-12.6). The primary endpoints were in-hospital, 30-day, and long-term all-cause mortality. Secondary outcomes were major adverse cardiovascular events (MACCE; composite of all-cause mortality, non-fatal myocardial infarction, non-fatal stroke or repeat revascularisation), bleeding and procedural outcomes at 30-day. Results: The median symptom-to-door time was 1.73 hours (interquartile range [IQR] 1.2, 2.8) for early presenters and 14.8 hours (IQR 13.2, 18.1) for late presenters. There was no significant difference in in-hospital mortality (6.5% vs 5.4%, p=0.53) and MACCE (9.0% vs 7.7%, p=0.52), nor 30-day mortality (7.4% vs 7.3%, p=0.94) and MACCE (11.1% vs 10.5%, p=0.77). There was no difference in major bleeding at 30-days (p=0.42). Long-term mortality did not differ between early and late presenters with hazard ratio 1.17 (95% confidence interval 0.71–1.95, p=0.54). Conclusion: PPCI in patients with late-presentation STEMI is not associated with worse short- or long-term clinical outcomes compared to those who present early. Further randomised controlled trials are needed to guide clinical practice.