Jia-Wei Wu1,2, Hao Hu2, Dan Li2, Li-Kun Ma2. 1. School of Medicine, Shandong University, Jinan 370100, China. 2. Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, China.
Abstract
BACKGROUND: For hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) who missed the reperfusion window, optimal timing for delayed revascularization remains controversial. METHODS: We investigated 7,698 consecutive patients without cardiogenic shock, serious heart failure, or thrombolysis who underwent delayed stenting (12 hours to 28 days after STEMI) at multiple centers in China. The patients were divided according to delayed PCI timing into very early (12-72 hours), early (3-7 days), intermediate (7-14 days) and late (14-28 days) groups. The primary outcome was in-hospital rate of major adverse cardiovascular events (MACE); secondary outcomes were in-hospital rates of all bleeding events, heart failure and sudden cardiac arrest (SCA). All endpoint events were a composite of the primary and secondary endpoints. RESULTS: In-hospital MACE rate was similar among groups (P=0.588). Patients who underwent late vs. very early, early and intermediate delayed PCI had higher in-hospital rates of secondary events (13% vs. 8.0%, 8.1% and 0.3%, P<0.001) and heart failure (11.8% vs. 6.2%, 6.3% and 7.6%, P<0.001, respectively). For all in-hospital events, the late vs. intermediate group was at higher risk (OR =1.26, 95% CI: 1.02 to 1.56, P=0.029); and in subgroup analysis, patients with Killip class II or III heart failure had similar rates (OR =1.02, 95% CI: 0.74 to 1.40, P=0.908); while women (OR =1.67, 95% CI: 1.07 to 2.62, P=0.024), and smokers (OR =1.46, 95% CI: 1.05 to 2.02, P=0.023) had higher rates. CONCLUSIONS: Late delayed PCI (14-28 days) after STEMI was associated with a higher incidence of in-hospital adverse events particularly in women and smokers but not with Killip class II-III heart failure, which might allow medical treatment to improve function. 2019 Cardiovascular Diagnosis and Therapy. All rights reserved.
BACKGROUND: For hemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) who missed the reperfusion window, optimal timing for delayed revascularization remains controversial. METHODS: We investigated 7,698 consecutive patients without cardiogenic shock, serious heart failure, or thrombolysis who underwent delayed stenting (12 hours to 28 days after STEMI) at multiple centers in China. The patients were divided according to delayed PCI timing into very early (12-72 hours), early (3-7 days), intermediate (7-14 days) and late (14-28 days) groups. The primary outcome was in-hospital rate of major adverse cardiovascular events (MACE); secondary outcomes were in-hospital rates of all bleeding events, heart failure and sudden cardiac arrest (SCA). All endpoint events were a composite of the primary and secondary endpoints. RESULTS: In-hospital MACE rate was similar among groups (P=0.588). Patients who underwent late vs. very early, early and intermediate delayed PCI had higher in-hospital rates of secondary events (13% vs. 8.0%, 8.1% and 0.3%, P<0.001) and heart failure (11.8% vs. 6.2%, 6.3% and 7.6%, P<0.001, respectively). For all in-hospital events, the late vs. intermediate group was at higher risk (OR =1.26, 95% CI: 1.02 to 1.56, P=0.029); and in subgroup analysis, patients with Killip class II or III heart failure had similar rates (OR =1.02, 95% CI: 0.74 to 1.40, P=0.908); while women (OR =1.67, 95% CI: 1.07 to 2.62, P=0.024), and smokers (OR =1.46, 95% CI: 1.05 to 2.02, P=0.023) had higher rates. CONCLUSIONS: Late delayed PCI (14-28 days) after STEMI was associated with a higher incidence of in-hospital adverse events particularly in women and smokers but not with Killip class II-III heart failure, which might allow medical treatment to improve function. 2019 Cardiovascular Diagnosis and Therapy. All rights reserved.
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