Clinical Characteristics and Outcomes Stratified by Time to ST-Segment Elevation Myocardial Infarction Presentation

Abstract

There were few data on the clinical characteristics of ST-segment elevation myocardial infarction (STEMI) patients with late presentation (long symptom onset to door [hospital arrival] time). Among 719 consecutive patients with STEMI who underwent percutaneous coronary intervention (PCI) in the SAGA-ACS registry, we compared baseline characteristics and clinical outcomes between patients with early presentation (symptom onset to door time <2.3 hours) and late presentation (≥2.3 hours). The cut-off point of 2.3 hours was the median value for the present study population. The median onset to door time was 1.3 hours in the early presentation group, and 4.8 hours in the late presentation group. Door to balloon time was not different between the groups (62.0 minutes vs 60.5 minutes). Late night to early morning onset (OR, 2.03; 95% CI, 1.45 to 2.85), age ≥75 years (OR, 1.56; 95% CI, 1.09 to 2.22), and women (OR, 1.49; 95% CI, 1.03 to 2.16) were independently associated with the late presentation, while culprit lesions in right coronary artery (RCA) was inversely associated the late presentation (OR, 0.62; 95% CI, 0.46 to 0.85). During the median 2.7 years follow-up, the cumulative incidence of all-cause death was numerically, but not statistically, higher in the late presentation group than in the early presentation group (16.3% vs 11.6% at 3 years, HR, 1.42; 95% CI, 0.97 to 2.07; p = 0.07). In conclusion, among patients with STEMI who underwent PCI, late night to early morning onset, advanced age, women, and culprit lesions in non-RCA were strongly associated with the late presentation. Strategies for minimizing symptom onset to door time should be targeted especially in these patients.