Kyung Hoon Cho1, Xiongyi Han1, Joon Ho Ahn1, Dae Young Hyun1, Min Chul Kim2, Doo Sun Sim2, Young Joon Hong2, Ju Han Kim2, Youngkeun Ahn2, Jin Yong Hwang3, Seok Kyu Oh4, Kwang Soo Cha5, Cheol Ung Choi6, Kyung-Kuk Hwang7, Hyeon Cheol Gwon8, Myung Ho Jeong9. 1. Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea. 2. Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea. 3. Department of Cardiology, Gyeongsang National University, School of Medicine, Jinju, Republic of Korea. 4. Department of Cardiology, Wonkwang University Hospital, Iksan, Republic of Korea. 5. Department of Cardiology, Pusan National University Hospital, Busan, Republic of Korea. 6. Department of Cardiology, Korea University Guro Hospital, Seoul, Republic of Korea. 7. Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea. 8. Department of Cardiology, Seoul Samsung Medical Center, Seoul, Republic of Korea. 9. Department of Cardiology, Chonnam National University Hospital, Gwangju, Republic of Korea; Department of Cardiology, Chonnam National University Medical School, Gwangju, Republic of Korea. Electronic address: myungho@chollian.net.
Abstract
BACKGROUND: Real-world data on baseline characteristics, clinical practice, and outcomes of late presentation (12 to 48 h of symptom onset) in patients with ST-segment elevation myocardial infarction (STEMI) are limited. OBJECTIVES: This study aimed to investigate real-world features of STEMI late presenters in the contemporary percutaneous coronary intervention (PCI) era. METHODS: Of 13,707 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health database, 5,826 consecutive patients diagnosed with STEMI within 48 h of symptom onset during 2011 to 2015 were categorized as late (12 to 48 h; n = 624) or early (<12 h; n = 5,202) presenters. Coprimary outcomes were 180-day and 3-year all-cause mortality. RESULTS: Late presenters had remarkably worse clinical outcomes than early presenters (180-day mortality: 10.7% vs. 6.8%; 3-year mortality: 16.2% vs. 10.6%; both log-rank p < 0.001), whereas presentation at ≥12 h of symptom onset was not independently associated with increased mortality after STEMI. The use of invasive interventional procedures abruptly decreased from the first (<12 h) to the second (12 to 24 h) 12-h interval of symptom-to-door time ("no primary PCI strategy" increased from 4.9% to 12.4%, and "no PCI" from 2.3% to 6.6%; both p < 0.001). Mortality rates abruptly increased from the first to the second 12-h interval of symptom-to-door time (from 6.8% to 11.2% for 180-day mortality; from 10.6% to 17.3% for 3-year mortality; all p < 0.05). CONCLUSIONS: Data from a nationwide prospective Korean registry reveal that inverse steep differences in the use of invasive interventional procedures and mortality rates were found between early and late presenters after STEMI. A multidisciplinary approach is required in identifying late presenters of STEMI who can benefit from invasive interventional procedures until further studied.
BACKGROUND: Real-world data on baseline characteristics, clinical practice, and outcomes of late presentation (12 to 48 h of symptom onset) in patients with ST-segment elevation myocardial infarction (STEMI) are limited. OBJECTIVES: This study aimed to investigate real-world features of STEMI late presenters in the contemporary percutaneous coronary intervention (PCI) era. METHODS: Of 13,707 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health database, 5,826 consecutive patients diagnosed with STEMI within 48 h of symptom onset during 2011 to 2015 were categorized as late (12 to 48 h; n = 624) or early (<12 h; n = 5,202) presenters. Coprimary outcomes were 180-day and 3-year all-cause mortality. RESULTS: Late presenters had remarkably worse clinical outcomes than early presenters (180-day mortality: 10.7% vs. 6.8%; 3-year mortality: 16.2% vs. 10.6%; both log-rank p < 0.001), whereas presentation at ≥12 h of symptom onset was not independently associated with increased mortality after STEMI. The use of invasive interventional procedures abruptly decreased from the first (<12 h) to the second (12 to 24 h) 12-h interval of symptom-to-door time ("no primary PCI strategy" increased from 4.9% to 12.4%, and "no PCI" from 2.3% to 6.6%; both p < 0.001). Mortality rates abruptly increased from the first to the second 12-h interval of symptom-to-door time (from 6.8% to 11.2% for 180-day mortality; from 10.6% to 17.3% for 3-year mortality; all p < 0.05). CONCLUSIONS: Data from a nationwide prospective Korean registry reveal that inverse steep differences in the use of invasive interventional procedures and mortality rates were found between early and late presenters after STEMI. A multidisciplinary approach is required in identifying late presenters of STEMI who can benefit from invasive interventional procedures until further studied.
Authors: Yu Ri Kim; Myung Ho Jeong; Min Jeong An; Xiongyi Han; Kyung Hoon Cho; Doo Sun Sim; Young Joon Hong; Ju Han Kim; Youngkeun Ahn Journal: Yonsei Med J Date: 2022-02 Impact factor: 2.759
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Authors: Mats de Lange; Ana Sofia Carvalho; Óscar Brito Fernandes; Hester Lingsma; Niek Klazinga; Dionne Kringos Journal: Int J Environ Res Public Health Date: 2022-03-08 Impact factor: 3.390