Revascularization in Late-Presenting STEMI Patients

Quick Takes

  • Findings from this retrospective analysis from an observational registry suggest that revascularization of STEMI patients presenting between 12–48 hours of symptom onset (latecomers) is associated with significant short- and long-term mortality benefit.
  • Revascularization was associated with a 35% relative risk reduction in mortality.

Study Questions:

What are the patient characteristics, temporal trends, and impact of revascularization in a large population of latecomer patients with ST-segment elevation myocardial infarction (STEMI)?

Methods:

Data from three nationwide observational studies from the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) program over a 1-month period in 2005, 2010, and 2015 were analyzed. Patients presenting between 12–48 hours after symptom onset were classified as latecomers.

Results:

A total of 6,273 STEMI patients were included in the three cohorts, 1,169 (18.6%) of whom were latecomers. Patients treated with fibrinolysis and patients deceased within 2 days after admission were excluded. A total of 1,077 patients were analyzed, of whom 729 (67.7%) were revascularized within 48 hours after hospital admission. At 30-day follow-up, the all-cause death rate was significantly lower among revascularized latecomers (2.1% vs. 7.2%; p < 0.001). After a median follow-up of 58 months, the rate of all-cause death was 30.4 (95% confidence interval [CI], 25.7-35.9) per 1,000 patient-years in the revascularized latecomers group versus 78.7 (95% CI, 67.2-92.3) per 1,000 patient-years in the nonrevascularized latecomers group (p < 0.001). In multivariate analysis, revascularization of latecomer STEMI patients was independently associated with a significant reduction of mortality occurrence during follow-up (hazard ratio, 0.65; 95% CI, 0.50-0.84; p = 0.001).

Conclusions:

Coronary revascularization of latecomer STEMI patients is associated with better short- and long-term clinical outcomes.

Perspective:

Findings from this retrospective analysis from an observational registry suggest that revascularization of STEMI patients presenting between 12–48 hours of symptom onset (latecomers) is associated with significant short- and long-term mortality benefit. Trends from 2005–2015 suggest overall reduction in ‘latecomers’ and increasing rates of revascularization over time. Whether benefit was derived because of revascularization of infarct-related arteries and/or noninfarct-related arteries (more likely to have complete revascularization), whether findings can be applied to other systems of STEMI care outside of France, or benefits of revascularization between 48–72 hours from symptom onset remains to be determined.

Clinical Topics: Acute Coronary Syndromes, Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Stable Ischemic Heart Disease, Vascular Medicine, Cardiac Surgery and Arrhythmias, Cardiac Surgery and SIHD, Interventions and ACS, Interventions and Vascular Medicine, Chronic Angina

Keywords: Acute Coronary Syndrome, Anterior Wall Myocardial Infarction, Fibrinolysis, Myocardial Infarction, Myocardial Revascularization, Non-ST Elevated Myocardial Infarction, Patient Admission, Risk Reduction Behavior, Secondary Prevention, ST Elevation Myocardial Infarction


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