Late Percutaneous Coronary Intervention Prevents Left Ventricular Remodeling and Improves Clinical Outcomes in Patients With ST‐Elevation Myocardial Infarction

Abstract

Background:The optimal strategy for treating late presenters of ST-elevation myocardial infarction (STEMI) remains uncertain. Hypothesis: percutaneous coronary intervention (PCI) has a favorable effect on left ventricular (LV) remodeling and clinical outcomes in late presenters of STEMI. Methods: Patients with STEMI who were hospitalized between 2009 and 2011 at 7 PCI-capable hospitals in China were selected. Cardiac characteristics were reassessed by echocardiography between August 2013 and January 2014. The clinical endpoints were evaluated during a median follow-up period of 36 months. Results: 1090 patients who either underwent late PCI (n = 786) or received standard medical therapy alone (n = 304) was analyzed. Left ventricular remodeling was more pronounced in the conservative-treatment group. Logistic regression revealed that late PCI was independently and negatively correlated with LV remodeling (odds ratio: 0.356, 95% confidence interval [CI]: 0.251-0.505, P < 0.001). Kaplan-Meier analysis showed the lower risks of major adverse cardiovascular events (MACE), all-cause death, and rehospitalization for heart failure in the late-PCI group. Multivariate Cox regression revealed that late PCI was significantly associated with lower risks for MACE, all-cause death, and rehospitalization for heart failure both in all patients (hazard ratio [HR]: 0.507, 95% CI: 0.412-0.625, P < 0.001; HR: 0.419, 95% CI: 0.314-0.559, P < 0.001; and HR: 0.583, 95% CI: 0.379-0.896, P = 0.014, respectively) and in the matched patients (HR: 0.466, 95% CI: 0.358-0.607, P < 0.001; HR: 0.398, 95% CI: 0.277-0.571, P < 0.001; and HR: 0.498, 95% CI: 0.283-0.878, P = 0.016, respectively) by propensity-score analysis. Conclusions: Late-PCI strategy prevents LV remodeling and improves clinical outcomes in STEMI patients compared with conservative strategies.

Temporal dynamics of immune response following prolonged myocardial ischemia/reperfusion with and without cyclosporine A

“…Hypothetically, reperfusion opens the routes for inflammatory cells to and from the site of injury and therefore promotes faster immune response and subsequently faster healing [3]. The identical dynamics of immune response in brief and prolonged I/R, data on delayed immune response in permanent ischemia [11, 22], and evidence that late reperfusion has a more favorable outcome than ischemia [2–5] suggest that late reperfusion promotes a remarkable modulatory effect on the immune response after MI. In this respect, knowledge of the normal immune response following prolonged ischemia is essential for molecular cardiology.…”

“…Early reperfusion is obviously a preferred therapy for myocardial infarction. However, a high proportion of patients are admitted beyond the time window when successful rescue of the myocardium is possible [1, 2]. Kim and Braunwald [3] have proposed that late reperfusion – too late to reduce myocardial infarct size, but early enough to favorably affect infarct healing – also appears to limit infarct expansion and left ventricular (LV) remodeling (the open-artery hypothesis).…”

“…Kim and Braunwald [3] have proposed that late reperfusion – too late to reduce myocardial infarct size, but early enough to favorably affect infarct healing – also appears to limit infarct expansion and left ventricular (LV) remodeling (the open-artery hypothesis). Late reperfusion has shown its efficacy in both animal and human research [2–5]. However, the therapeutic potential of late reperfusion is significantly lower than that of early reperfusion.…”

Heart rate and left ventricular adverse remodelling after ST-elevation myocardial infarction

“…Papillary muscles were excluded from the myocardial mass and included into the LV volume [5]. LVR was defined as an increase in LV end-diastolic volume (LVEDV) ≥ 15 % from baseline to follow-up investigation [14,15].…”

High cystatin C levels predict long‐term mortality in patients with ST‐segment elevation myocardial infarction undergoing late percutaneous coronary intervention: A retrospective study

“…Whether late PCI is adequately beneficial is controversial. In our previous study, late PCI in STEMI patients prevented cardiac remodeling and improved clinical outcomes . Therefore, the exploration of effective prognostic factors for the late PCI patients is of clinical significance, and in this context, cystatin C (cys C) is proposed to be a potential prognostic factor in patients with STEMI who have undergone primary PCI in the literature …”