Optimal timing of percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction presenting late.

IF 0.6 Q4 SURGERY

Kardiochirurgia I Torakochirurgia Polska Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI:10.5114/kitp.2024.143685

Haiyan Jia, Weifeng Zhang, Shengqi Jia, Jun Zhang, Zhanwen Xu, Yaqin Li

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引用次数: 0

Abstract

Introduction: Primary percutaneous coronary intervention (PPCI) is an effective method for the clinical treatment of acute ST-segment elevation myocardial infarction (STEMI). For patients who miss the optimal time window, optimal management of these patients remains controversial.

Aim: To compare the effects of different timing of percutaneous coronary intervention on the long-term prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) with time from symptom onset > 12 hours.

Material and methods: Elderly acute STEMI patients with time from symptom onset > 12 hours in the period from July 2021 to July 2022 in the Department of Cardiology, Affiliated Hospital of Hebei University, were randomly divided into four groups: group 1 (immediate invasive strategy, percutaneous coronary interventions (PCI) < 24 hours after symptoms onset, n = 80), group 2 (early invasive strategy, 24-< 72 hours after symptoms onset, n = 80), group 3 (delayed invasive strategy after symptoms onset, 72-< 168 hours after symptoms onset, n = 80), and group 4 (late PCI group after symptoms onset, ≥ 168 hours after symptoms onset, n = 80). Primary study end points were 12-month cardiac mortality, nonfatal myocardial infarction (MI), target-vessel revascularization, and heart failure-related rehospitalization.

Results: There were no significant differences between groups in cardiac mortality, nonfatal MI and target-vessel revascularization. During follow-up, heart failure-related rehospitalization was higher in group 1 than in the other groups (18.8% vs. 5.1% vs. 7.4% vs. 6.3%, p = 0.010). Compared with group 1, group 2, group 3 and group 4 had lower heart failure-related rehospitalization (HR = 0.250, 95% CI: 0.083-0.753, p = 0.014) (HR = 0.377, 95% CI: 0.146-0.971, p = 0.043) (HR = 0.320, 95% CI: 0.116-0.879, p = 0.027).

Conclusions: For acute STEMI patients who missed the optimal time of PCI, immediate PCI did not reduce adverse clinical outcomes.

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晚期急性 ST 段抬高型心肌梗死老年患者经皮冠状动脉介入治疗的最佳时机。

导言：原发性经皮冠状动脉介入治疗（PPCI）是临床治疗急性ST段抬高型心肌梗死（STEMI）的有效方法。目的：比较不同经皮冠状动脉介入治疗时机对急性 ST 段抬高型心肌梗死（STEMI）老年患者（症状出现时间大于 12 小时）长期预后的影响：将2021年7月至2022年7月期间在河北大学附属医院心内科就诊的发病时间大于12小时的老年急性STEMI患者随机分为四组：第1组（即刻有创策略，症状发生后经皮冠状动脉介入治疗（PCI）< 24小时，n = 80），第2组（早期有创策略，症状发生后24-< 72小时，n = 80），第3组（症状发生后延迟有创策略，症状发生后72-< 168小时，n = 80），第4组（症状发生后晚期PCI组，症状发生后≥ 168小时，n = 80）。主要研究终点为12个月的心脏死亡率、非致死性心肌梗死（MI）、靶血管血运重建和心衰相关再住院：各组在心脏死亡率、非致命性心肌梗死和靶血管血运重建方面无明显差异。随访期间，第一组心衰相关再住院率高于其他组（18.8% vs. 5.1% vs. 7.4% vs. 6.3%，P = 0.010）。与第一组相比，第二组、第三组和第四组的心衰相关再住院率较低（HR = 0.250，95% CI：0.083-0.753，p = 0.014）（HR = 0.377，95% CI：0.146-0.971，p = 0.043）（HR = 0.320，95% CI：0.116-0.879，p = 0.027）：对于错过最佳PCI时间的急性STEMI患者，立即PCI并不能减少不良临床结局。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Kardiochirurgia I Torakochirurgia Polska 医学-外科

CiteScore

0.90

自引率

14.30%

发文量

审稿时长

6-12 weeks

期刊介绍： Polish Journal of Thoracic and Cardiovascular Surgery is a quarterly aimed at cardiologists, cardiosurgeons and thoracic surgeons. Includes the original works (experimental, research and development), illustrative and casuistical works about cardiology and cardiosurgery.