Advanced and more advanced revascularization in STEMI patients: which is better?

Abstract

Objective To compare the long-term prognosis of patients who experienced acute ST-segment elevation myocardial infarction and underwent either late percutaneous coronary intervention (PCI) within a period of 2 days to less than 1 week or more advanced PCI within 1 week to less than 1 month. Methods We enrolled 198 patients from Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, between June 2019 and August 2022. These patients had experienced acute ST-segment elevation myocardial infarction and underwent either late PCI or more advanced PCI. Long-term follow-up was conducted through outpatient clinic visits or telephone interviews. The study endpoints included all-cause death, nonfatal myocardial infarction, and New York Heart Association class IV heart failure. We utilized the Kaplan-Meier method to illustrate the cumulative incidence of endpoint events in both patient groups. Statistical significance in survival differences was assessed using the log-rank test. Additionally, the Cox proportional risk model was employed to analyze whether the timing of late revascularization procedures had an impact on the long-term prognosis of the patients. Results Among the 198 patients included in the study, 108 underwent late PCI, while 90 underwent more advanced PCI. The majority were male (73.74%), with an average age of 62 ± 13 years. The follow-up period averaged 20 (15, 28) months, and all patients successfully completed the follow-up process. Analysis based on the Kaplan-Meier method revealed that the incidence of all-cause death [11.1% vs. 5.6%, P=0.165], nonfatal myocardial infarction [7.4% vs. 7.8%, P=0.922], New York Heart Association class IV heart failure [2.8% vs. 3.3%, P>0.999], and the composite endpoint [18.5% vs. 14.4%, P=0.444] were not statistically significant between the late PCI and more advanced PCI groups. After adjusting for factors like left ventricular ejection fraction, renin-angiotensin system inhibitors, ?-blockers, and statins, the results still indicated no statistically significant differences between the two groups in terms of rates for all-cause death, recurrent myocardial infarction, New York Heart Association class IV heart failure, and composite endpoints (P=0.05). Conclusion This study's 20 (15, 28) months follow-up suggests that patients experiencing acute ST-segment elevation myocardial infarction have a comparable prognosis regardless of whether they underwent late or more advanced PCI.