Percutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI
| Autor: | Etienne Puymirat, Gilles Lemesle, Clément Delmas, Vincent Bataille, Frédéric Bouisset, Jean Ferrières, Didier Blanchard, Fast-Mi investigators, Francois Schiele, Pierre Coste, Nadia Aissaoui, Pascal Motreff, Guillaume Cayla, Edouard Gerbaud, Nicolas Danchin, Tabassome Simon, Loic Belle |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome Myocardial revascularization Percutaneous medicine.medical_treatment Revascularization Time-to-Treatment Percutaneous Coronary Intervention Internal medicine Fibrinolysis medicine Humans Registries Myocardial infarction Aged business.industry Mortality rate Middle Aged medicine.disease Cardiology ST Elevation Myocardial Infarction Female Observational study France Cardiology and Cardiovascular Medicine business |
| Zdroj: | Journal of the American College of Cardiology. 78:1291-1305 |
| ISSN: | 0735-1097 |
| DOI: | 10.1016/j.jacc.2021.07.039 |
| Popis: | The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) presenting late-12 hours following symptom onset-is still under debate.The purpose of this study was to describe characteristics, temporal trends, and impact of revascularization in a large population of latecomer STEMI patients.The authors analyzed the data of 3 nationwide observational studies from the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) program, conducted over a 1-month period in 2005, 2010, and 2015. Patients presenting between 12 and 48 hours after symptom onset were classified as latecomers.A total of 6,273 STEMI patients were included in the 3 cohorts, 1,169 (18.6%) of whom were latecomers. After exclusion of patients treated with fibrinolysis and patients deceased within 2 days after admission, 1,077 patients were analyzed, of whom 729 (67.7%) were revascularized within 48 hours after hospital admission. At 30-day follow-up, all-cause death rate was significantly lower among revascularized latecomers (2.1% vs 7.2%; P 0.001). After a median follow-up of 58 months, the rate of all-cause death was 30.4 (95% CI: 25.7-35.9) per 1,000 patient-years in the revascularized latecomers group vs 78.7 (95% CI: 67.2-92.3) per 1,000 patient-years in the nonrevascularized latecomers group (P 0.001). In multivariate analysis, revascularization of latecomer STEMI patients was independently associated with a significant reduction of mortality occurrence during follow-up (HR: 0.65 [95% CI: 0.50-0.84]; P = 0.001).Coronary revascularization of latecomer STEMI patients is associated with better short and long-term clinical outcomes. |
| Databáze: | OpenAIRE |
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