Frequency and outcomes of STEMI patients presenting between 12 and 24 h after symptom onset: Late‐presenting STEMI

Abstract

Objectives To assess the characteristics and prognosis of ST‐elevation myocardial infarction (STEMI) patients, presenting between 12 and 24 h after symptom onset, in contemporary regional STEMI systems of care in the United States. Background Previous observational studies have been inconsistent regarding the benefit of primary percutaneous coronary intervention (PCI) compared with conservative management for late‐presenting STEMI patients and the majority of randomized trials are from the fibrinolytic era. Methods Using a two‐center registry‐based cohort from March 2003 to December 2020, we evaluated the frequency, clinical characteristics, and outcomes of STEMI patients, stratified by symptom onset to balloon time: <3, 3−6, 6−12, and 12−24 h (late presenters). Results Among 5427 STEMI patients with available symptom onset time, 6.2% were late presenters, which increased to 11% during the early phase of the Covid‐19 pandemic. As symptom onset to balloon time increased, patients were more likely to be older, female, and have a history of hypertension and diabetes mellitus. Late presenters with an identifiable culprit lesion were less likely to be revascularized with PCI (96%, 96%, 95%, and 92%; p for trend = 0.004) and had a longer median door‐to‐balloon time (82, 109, 107, and 117 min; p for trend < 0.001). In‐hospital and 1‐year death risks were comparable between late and earlier presenters. Conclusion Despite the unfavorable risk profile and longer door‐to‐balloon time, clinical outcomes of late presenters were similar to those presenting within 12 h of symptom onset.

Effect of delayed hospitalization on patients with non-ST-segment elevation myocardial infarction and complex lesions undergoing successful new-generation drug-eluting stents implantation

“…In the present study, patients with SDT ≥ 24 h group were more likely to be older and tended to have a high cardiovascular risk profile (such as a high mean GRACE risk score and higher rates of Killip class II/III and diabetes mellitus) than did patients with < 24 h in both the complex and non-complex groups (Table 1 ). Interestingly, these characteristics of NSTEMI patients in our study population were similar to those of patients who presented later (between 12 and 24 h after symptom onset) in other studies 3 , 5 , 12 . In general, older patients may have difficulty in moving and may need help with transportation, which may contribute to delayed hospitalization 13 .…”

PCI for late STEMI: Better late than never?

“…• An algorithm for the management of late STEMI is presented describe a cohort of 5427 STEMI patients, comparing those who presented <3 h (45%), 3−6 h (36%), 6−12 h (13%), and 12−24 h (6%) from symptom onset. 4 Late STEMI presenters (12−24 h) were more likely to be older, female, hypertensive and diabetic (p ≤ 0.001 for all) and had longer door-to-balloon times (p < 0.001). Despite these adverse factors, outcomes of late presenters were similar to early presenters including in-hospital mortality (4% vs. 2%, p = 0.7), 1-year mortality (6% vs. 5%, p = 0.8) and 1 year major adverse cardiac events (11% vs. 8%, p = 0.3).…”

“…Adding to the data of Bouisset et al in this issue of Catheterization and Cardiovascular Interventions, Griffin et al describe a cohort of 5427 STEMI patients, comparing those who presented <3 h (45%), 3−6 h (36%), 6−12 h (13%), and 12−24 h (6%) from symptom onset 4 . Late STEMI presenters (12−24 h) were more likely to be older, female, hypertensive and diabetic ( p ≤ 0.001 for all) and had longer door‐to‐balloon times ( p < 0.001).…”