Author + information
- Chinedu Angela Igwe,
- Ottorino Costnatini,
- Marc Penn and
- Kevin Silver
Background: Guidelines state that Percutaneous Coronary Intervention (PCI) is a class I indication for STEMI within 12 hours of symptom onset, and a class IIa recommendation for patients presenting between 12 and 24 hours after STEMI onset. The OAT trial demonstrated that in patients with total occlusion of the infarct-related artery presenting 72 hrs-30 days after MI, PCI compared with conservative therapy did not decrease death, re-infarction, or heart failure during 4 year follow up. There is no clear recommendation on mode of therapy for patients presenting between 24-72 hours after a myocardial infarction.
Methods: We retrospectively reviewed 969 consecutive STEMI patient charts from Jan 2013 – Dec 2015 for the time of symptom onset. Patients who presented < 24 hours, > 72 hours or who did not have clear documentation of time of symptom onset were excluded. Timing of PCI, death, heart failure, and readmission were abstracted.
Results: 45 patients presented 24-72 hours after STEMI onset. The mean age was 65 ± 16 years. There were 20 women and 25 men. Of the 45 patients, 43 (96%) were revascularized with PCI. 2 patients were treated medically. Delayed intervention (mean 24 hours) occurred in 8 (17.7%) patients. Immediate intervention (mean 30mins) occurred in 35 (77.8%) patients.
Of the 43 patients, 12 (26.7%) had hospital LOS >3 days. Among the patients with immediate intervention versus delayed intervention, LOS > 3 days was 7 (20%) vs 5 (62.5%) days respectively (p<0.05). The composite outcome of in-hospital death, NYHA III-IV heart failure and 30-day readmission occurred in 17 patients (37.8%); 9 patients had <30 day readmission; 3 died and 4 patients developed NYHAIII-IV. The composite outcome occurred in 13 (37.1%) patients with immediate intervention versus 3 (37.5%) patients with delayed intervention (p>0.05).
Conclusions: Immediate revascularization in patients presenting with MI 24-72 hours after symptom onset significantly decreases the LOS. There is no significant difference in the composite of death, NYHA III-IV heart failure and 30 day readmission. A larger study is needed to determine if the reduction in LOS with immediate PCI may result in cost savings while maintaining quality outcomes.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Unusual Presentations of ACS
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1297-326
- 2017 American College of Cardiology Foundation