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Background We evaluated the effect of delayed hospitalization (symptom-to-door time [STD] ≥ 24 h) on 3-year clinical outcomes according to renal function in patients with non-ST-segment elevation myocardial infarction (NSTEMI) undergoing new-generation drug-eluting stent (DES) implantation. Methods A total of 4513 patients with NSTEMI were classified into chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m 2 , n = 1118) and non-CKD (eGFR ≥ 60 mL/min/1.73 m 2 , n = 3395) groups. They were further sub-classified into groups with (STD ≥ 24 h) and without (STD < 24 h) delayed hospitalization. The primary outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as all-cause death, recurrent myocardial infarction, any repeat coronary revascularization, and stroke. The secondary outcome was stent thrombosis. Results After multivariable-adjusted and propensity score analyses, the primary and secondary clinical outcomes were similar in patients with or without delayed hospitalization in both CKD and non-CKD groups. However, in both the STD < 24 h and STD ≥ 24 h groups, MACCE (p < 0.001 and p < 0.006, respectively) and mortality rates were significantly higher in the CKD group than in the non-CKD group. However, stent thrombosis rates were similar between the CKD and non-CKD groups and between the STD < 24 h and STD ≥ 24 h groups. Conclusions Chronic kidney disease appears to be a much more important determinant of MACCE and mortality rates than STD in patients with NSTEMI.

Background: Successful chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is known

and 24 hours after the procedure. ST resolution was estimated at 90 minutes in the worst lead.RESULTS 82 patients (70 males, 12 females) with a mean age of 56,9 AE 12,7 years were evaluated. The results showed significant reduction in both Qtc (mean 460.81 AE 26.17 ms vs 439.19 AE 18.43 ms ; p < 0,001) and Qtd (mean 60.68 AE 7.57 ms vs 35.78 AE 10.25 ms; p < 0,001) before and 24 hours after primary PCI while no significant difference was noticed in the Qtc (460.81 AE 26.17 vs 454.39 AE 35.89 ; p ¼ 0.19) and Qtd (60.68 AE 7.57 vs 59.17 AE 7.54; p ¼ 0.20) before and 90 minutes after the procedure.Preprocedural QTd values were similar in patients with and without ST resolution (67 AE 5.77 vs 62 AE 7.53; p ¼ 0.10). 24h after PPCI QTd decreased only in patients with ST resolution (34.61 AE 9.04 vs 58.5 AE 4.12; p <0.001). Multivariate analysis showed that ST resolution was an independent predictor of QTd after successful recanalization (standardized regression coefficient ¼ -0.684; p ¼ 0.004).CONCLUSIONS In addition to a successful opening of the culprit artery, myocardial reperfusion must be achieved to improve electrical stability and reduce repolarization heterogeneity. Recovery of myocardial electrical homogeneity is not immediate and begins 24 hours after revascularization as assessed by QTc and QTd.

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