Factors Influencing Late Prognosis in Patients With Acute St-Segment Elevation Myocardial Infarction Treated With Direct Percutaneous Coronary Intervention

Abstract

Objective Investigating factors influencing the late prognosis of patients with acute ST-segment elevation myocardial infarction (STEMI) treated by direct percutaneous coronary intervention (PCI). Methods We retrospectively analyzed 349 STEMI patients treated with direct PCI. Patients were categorized based on catheter lab activation time (CLAT) (≤15 min or > 15 min), time of arrival (working-hours or out-of-hours), and mode of arrival (EMS transportation or self-presentation). The primary endpoint was the 2-year major adverse cardiovascular events (MACE), defined as all-cause death, nonfatal myocardial infarction, and target vessel revascularization. Results Patients with CLAT ≤15 minutes showed significant differences in oxygen saturation, FMC-to-device time, symptom-to-device time, symptom-to-FMC time, presentation mode, presentation duration, and MACE (all P < 0.005). Self-presentation (OR = 0.593, 95%CI: 0.413–0.759) and out-of-hours presentation (OR = 0.612, 95%CI: 0.433–0.813) were risk factors for CLAT >15 min. The working-hours group showed significant differences in FMC-to-device time, activation-to-arrival time at the catheter lab, and the number of cases with activation time ≤ 15 min (all P < 0.005). The EMS and self-presentation groups differed significantly in age, blood pressure, FMC-to-device time, and ECG-to-CLAT (all P < 0.005). Conclusion Reducing CLAT to 15 minutes significantly lowers the 2-year MACE rate. Self-presentation and out-of-hours presentation are risk factors for delayed catheter lab activation.