The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospective cohort study

Abstract

Background Early reperfusion of the coronary artery has become the first choice for patients with ST-segment elevation myocardial infarction (STEMI). How to deal with patients who miss the time window for early reperfusion is still controversial. Based on real-world data, this study was conducted to explore whether percutaneous coronary intervention (PCI) has an advantage over standard drug therapy in patients who miss the optimal treatment window. Methods Consecutive patients who were diagnosed with STEMI and met the inclusion criteria between 2009 and 2018 in our center were retrospectively included in this cohort study. The primary endpoint events were major adverse cardiac events (MACEs), including heart failure, sudden cardiac death, malignant arrhythmia, thrombi and bleeding events during the period of admission. Secondary endpoint events were components of MACEs. At the same time, we also evaluated angina pectoris at admission and discharge through Canadian Cardiovascular Society (CCS) grading. Results This study enrolled 417 STEMI patients and divided them into four groups (PCI < 3 days, 14.87%; 3 days<PCI < 7 days, 21.104%; PCI > 7 days, 34.29%; MED, 29.74%). During the period of admission, MACEs occurred in 52 cases. The incidence of MACEs was 11.29, 7.95, 4.20 and 25.81% in the four respective groups (p < 0.0001). The MED group had higher rates of MACEs (OR = 3.074; 95% CI 0.1.116–8.469, p = 0.03) and cardiac death (OR = 3.027; 95% CI 1.121–8.169, p = 0.029) compared to the PCI group. Although both treatments were effective in improving CCS grade at discharge, the PCI group improved more significantly (p < 0.0001). Conclusions In the real world, delayed PCI can be more effective in patients with angina symptoms at discharge and reduce the incidence of MACEs and cardiac death during hospitalization. The timing of intervention was independent of the occurrence of MACEs during hospitalization and of improvement in symptoms.

A Stacked Ensemble Framework through Synergistic Modeling for Adolescent Delinquency Classification

“…AUC values close to 1 indicate a high-quality model with good separability. AUC value nearing 0 indicates a poor model, which has the least separability [33]. Additionally, the model has no capacity for class separation when the AUC is 0.5.…”

Symptom-to-balloon time and risk of ventricular arrhythmias in patients with STEMI undergoing percutaneous coronary intervention: The VERY-STEMI study

“…There are several possible explanations for these findings. First, from a pathophysiological point of view, residual coronary antegrade flow and retrograde collateral circulation after MI ensures the survival of hibernating and stunned myocardium, and rescue of these cardiomyocytes can prevent myocardial remodeling and electrophysiological disorders [ 9 ]. Second, it has been proposed that patients with STEMI who present later (S2BT delay) are at a lower risk than those who present earlier because they have passed the initial high-risk period [ 36 ].…”

“…However, there is no standard criteria for dividing the timing of late and very-late revascularization. This study used 7d as the dividing point of late and very-late revascularization based on several clinical studies [ 9 , 16 , 17 ], which also used 7d as the dividing point and suggested that the clinical outcomes of patients with STEMI undergoing PCI within 7d and after 7d of onset might be different.…”

“…However, it has been reported that only about 30% of STEMI patients who undergo PCI receive pPCI in China. Besides, many patients in grass-roots areas miss the best PCI opportunity after being transferred to the chest pain center in a PCI qualified hospital due to pre-hospital delay and inter-hospital referral or even refuse PCI [ 9 ]. Considering the large number of MI that occurs in China every year, this percentage is relatively low [ 10 ].…”

Treatment outcome in patients with acute ST elevation myocardial infarction where more than 12 hours and less than 48 hours have passed from the onset of symptoms

“…Pri donošenju odluke o tretmanu ovih bolesnika, u obzir bi trebalo uzeti i intermitentnu, ili delimičnu okluziju koronarne arterije, stepen kolateralne cirkulacije, ishemijsko prekondicioniranje i metabolički status unutar područja ishemije. Sve ovo su faktori od značaja kada je u pitanju planiranje adekvatnog tretmana ovih pacijenata [15].…”