Author + information
- Raffaele Bugiardini,
- Edina Cenko,
- Jinsung Yoon,
- Beatrice Ricci,
- Davor Milicic,
- Sasko Kedev,
- Zorana Vasiljevic,
- Olivia Manfrini,
- Mihaela van der Schaar and
- Lina Badimon
Data supporting the use of percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) beyond a 12-hour cut-off are sparse and contradictory. We aimed to investigate whether different delays to hospital presentation and patient clinical characteristics may interfere with PCI resulting in a heterogeneous treatment effect in a population of clinically stable patients with STEMI presenting 12-48 hours after symptom onset.
Cohort study using a population based registry (ISACS-TC, NCT01218776) consisting of 2,730 clinically stable patients with STEMI who presented 12-48 hours after symptom onset undergoing PCI or routine medical treatment (RMT). To adjust for confounding, we used inverse probability of treatment weighted (IPTW) models. Effect modifier changes were estimated by tests for interaction. The primary outcome was the composite of 30-day all-cause mortality and severe left ventricular dysfunction (EF<30%). The secondary outcome was 30-day all-cause mortality
Baseline characteristics were well matched between PCI and RMT groups. There were significant interactions for the primary outcome (p=0.001), and the secondary outcome (p =0.006) and time from symptom onset to hospital presentation (>12-24 hours or ≥ 25-48 hours). Patients were, then, stratified based on their time from symptom onset to hospital presentation in two delay cohorts. Among patients presenting ≥ 25-48 hours after symptom onset, the primary outcome occurred in 5.4% of patients undergoing PCI compared with 8.7% of patients managed with RMT (OR: 0.60 95%CI 0.40-0.89). This benefit was driven mainly by a reduction in mortality with PCI (1.8% vs 5.7% OR: 0.30 95%CI 0.16-0.58). Estimates of PCI effect in the 25-48-hour sample varied with age (OR: 0.26 for patients ≥65 years old and 1.33 for those younger; interaction test P<0.001). There was no difference in outcomes of patients undergoing PCI between 12 and 24 hours.
Clinically, stable STEMI patients may benefit of PCI beyond the recommended 12-hour cut-off. Advantage varies considerably depending on PCI-related delay and patients’ age
Poster Hall, Hall A/B
Saturday, March 10, 2018, 10:00 a.m.-10:45 a.m.
Session Title: Important Issues Related to the Management of Patients With Acute Coronary Syndromes
Abstract Category: 02. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1130-443
- 2018 American College of Cardiology Foundation