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Clinical outcome following late reperfusion with percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

Nepper-Christensen, Lars ; Lønborg, Jacob ; Høfsten, Dan Eik ; Sadjadieh, Golnaz ; Schoos, Mikkel Malby ; Pedersen, Frants ; Jørgensen, Erik ; Kelbæk, Henning ; Haahr-Pedersen, Sune and Flensted Lassen, Jens , et al. (2021) In European Heart Journal: Acute Cardiovascular Care 10(5). p.523-531
Abstract

Background: Up to 40% of patients with ST-segment elevation myocardial infarction (STEMI) present later than 12 hours after symptom onset. However, data on clinical outcomes in STEMI patients treated with primary percutaneous coronary intervention (PCI) ≥12 hours after symptom onset are non-existent. We evaluated the association between primary PCI performed later than 12 hours after symptom onset and clinical outcomes in a large all-comer contemporary STEMI cohort. Methods: All STEMI patients treated with primary PCI in eastern Denmark from November 2009 to November 2016 were included and stratified by timing of the PCI. The combined clinical endpoint of all-cause mortality and hospitalisation for heart failure was identified from... (More)

Background: Up to 40% of patients with ST-segment elevation myocardial infarction (STEMI) present later than 12 hours after symptom onset. However, data on clinical outcomes in STEMI patients treated with primary percutaneous coronary intervention (PCI) ≥12 hours after symptom onset are non-existent. We evaluated the association between primary PCI performed later than 12 hours after symptom onset and clinical outcomes in a large all-comer contemporary STEMI cohort. Methods: All STEMI patients treated with primary PCI in eastern Denmark from November 2009 to November 2016 were included and stratified by timing of the PCI. The combined clinical endpoint of all-cause mortality and hospitalisation for heart failure was identified from nationwide Danish registries. Results: We included 6674 patients: 6108 (92%) were treated <12 hours and 566 (8%) were treated ≥12 hours after symptom onset. During a median follow-up period of 3.8 (interquartile range 2.3-5.6) years, 30-day, one-year and long-term cumulative rates of the combined endpoint were 11%, 17% and 25% in patients treated <12 hours and 21%, 29% and 37% in patients treated ≥12 hours after symptom onset (P > 0.001 for all). Late presentation was independently associated with an increased risk of an adverse clinical outcome (hazard ratio 1.42, 95% confidence interval 1.22-1.66; P < 0.001). Conclusions: Increasing duration from symptom onset to primary PCI was associated with an increased risk of an adverse clinical outcome in patients with STEMI, especially when the delay exceeded 12 hours.

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organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
clinical outcome, late reperfusion, primary percutaneous coronary intervention, ST-segment elevation myocardial infarction
in
European Heart Journal: Acute Cardiovascular Care
volume
10
issue
5
pages
9 pages
publisher
Oxford University Press
external identifiers
  • pmid:32419471
  • scopus:85164553697
ISSN
2048-8726
DOI
10.1177/2048872619886312
language
English
LU publication?
yes
id
cebca5cf-ffdd-4a01-ba42-652712107cdf
date added to LUP
2023-10-18 11:14:21
date last changed
2024-04-05 00:14:24
@article{cebca5cf-ffdd-4a01-ba42-652712107cdf,
  abstract     = {{<p>Background: Up to 40% of patients with ST-segment elevation myocardial infarction (STEMI) present later than 12 hours after symptom onset. However, data on clinical outcomes in STEMI patients treated with primary percutaneous coronary intervention (PCI) ≥12 hours after symptom onset are non-existent. We evaluated the association between primary PCI performed later than 12 hours after symptom onset and clinical outcomes in a large all-comer contemporary STEMI cohort. Methods: All STEMI patients treated with primary PCI in eastern Denmark from November 2009 to November 2016 were included and stratified by timing of the PCI. The combined clinical endpoint of all-cause mortality and hospitalisation for heart failure was identified from nationwide Danish registries. Results: We included 6674 patients: 6108 (92%) were treated &lt;12 hours and 566 (8%) were treated ≥12 hours after symptom onset. During a median follow-up period of 3.8 (interquartile range 2.3-5.6) years, 30-day, one-year and long-term cumulative rates of the combined endpoint were 11%, 17% and 25% in patients treated &lt;12 hours and 21%, 29% and 37% in patients treated ≥12 hours after symptom onset (P &gt; 0.001 for all). Late presentation was independently associated with an increased risk of an adverse clinical outcome (hazard ratio 1.42, 95% confidence interval 1.22-1.66; P &lt; 0.001). Conclusions: Increasing duration from symptom onset to primary PCI was associated with an increased risk of an adverse clinical outcome in patients with STEMI, especially when the delay exceeded 12 hours.</p>}},
  author       = {{Nepper-Christensen, Lars and Lønborg, Jacob and Høfsten, Dan Eik and Sadjadieh, Golnaz and Schoos, Mikkel Malby and Pedersen, Frants and Jørgensen, Erik and Kelbæk, Henning and Haahr-Pedersen, Sune and Flensted Lassen, Jens and Køber, Lars and Holmvang, Lene and Engstrøm, Thomas}},
  issn         = {{2048-8726}},
  keywords     = {{clinical outcome; late reperfusion; primary percutaneous coronary intervention; ST-segment elevation myocardial infarction}},
  language     = {{eng}},
  month        = {{05}},
  number       = {{5}},
  pages        = {{523--531}},
  publisher    = {{Oxford University Press}},
  series       = {{European Heart Journal: Acute Cardiovascular Care}},
  title        = {{Clinical outcome following late reperfusion with percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction}},
  url          = {{http://dx.doi.org/10.1177/2048872619886312}},
  doi          = {{10.1177/2048872619886312}},
  volume       = {{10}},
  year         = {{2021}},
}