Optimal timing of percutaneous coronary intervention in elderly patients with acute ST-segment elevation myocardial infarction presenting late.

IF 0.6 Q4 SURGERY Kardiochirurgia I Torakochirurgia Polska Pub Date : 2024-09-01 Epub Date: 2024-09-30 DOI:10.5114/kitp.2024.143685
Haiyan Jia, Weifeng Zhang, Shengqi Jia, Jun Zhang, Zhanwen Xu, Yaqin Li
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Abstract

Introduction: Primary percutaneous coronary intervention (PPCI) is an effective method for the clinical treatment of acute ST-segment elevation myocardial infarction (STEMI). For patients who miss the optimal time window, optimal management of these patients remains controversial.

Aim: To compare the effects of different timing of percutaneous coronary intervention on the long-term prognosis of elderly patients with acute ST-segment elevation myocardial infarction (STEMI) with time from symptom onset > 12 hours.

Material and methods: Elderly acute STEMI patients with time from symptom onset > 12 hours in the period from July 2021 to July 2022 in the Department of Cardiology, Affiliated Hospital of Hebei University, were randomly divided into four groups: group 1 (immediate invasive strategy, percutaneous coronary interventions (PCI) < 24 hours after symptoms onset, n = 80), group 2 (early invasive strategy, 24-< 72 hours after symptoms onset, n = 80), group 3 (delayed invasive strategy after symptoms onset, 72-< 168 hours after symptoms onset, n = 80), and group 4 (late PCI group after symptoms onset, ≥ 168 hours after symptoms onset, n = 80). Primary study end points were 12-month cardiac mortality, nonfatal myocardial infarction (MI), target-vessel revascularization, and heart failure-related rehospitalization.

Results: There were no significant differences between groups in cardiac mortality, nonfatal MI and target-vessel revascularization. During follow-up, heart failure-related rehospitalization was higher in group 1 than in the other groups (18.8% vs. 5.1% vs. 7.4% vs. 6.3%, p = 0.010). Compared with group 1, group 2, group 3 and group 4 had lower heart failure-related rehospitalization (HR = 0.250, 95% CI: 0.083-0.753, p = 0.014) (HR = 0.377, 95% CI: 0.146-0.971, p = 0.043) (HR = 0.320, 95% CI: 0.116-0.879, p = 0.027).

Conclusions: For acute STEMI patients who missed the optimal time of PCI, immediate PCI did not reduce adverse clinical outcomes.

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晚期急性 ST 段抬高型心肌梗死老年患者经皮冠状动脉介入治疗的最佳时机。
导言:原发性经皮冠状动脉介入治疗(PPCI)是临床治疗急性ST段抬高型心肌梗死(STEMI)的有效方法。目的:比较不同经皮冠状动脉介入治疗时机对急性 ST 段抬高型心肌梗死(STEMI)老年患者(症状出现时间大于 12 小时)长期预后的影响:将2021年7月至2022年7月期间在河北大学附属医院心内科就诊的发病时间大于12小时的老年急性STEMI患者随机分为四组:第1组(即刻有创策略,症状发生后经皮冠状动脉介入治疗(PCI)< 24小时,n = 80),第2组(早期有创策略,症状发生后24-< 72小时,n = 80),第3组(症状发生后延迟有创策略,症状发生后72-< 168小时,n = 80),第4组(症状发生后晚期PCI组,症状发生后≥ 168小时,n = 80)。主要研究终点为12个月的心脏死亡率、非致死性心肌梗死(MI)、靶血管血运重建和心衰相关再住院:各组在心脏死亡率、非致命性心肌梗死和靶血管血运重建方面无明显差异。随访期间,第一组心衰相关再住院率高于其他组(18.8% vs. 5.1% vs. 7.4% vs. 6.3%,P = 0.010)。与第一组相比,第二组、第三组和第四组的心衰相关再住院率较低(HR = 0.250,95% CI:0.083-0.753,p = 0.014)(HR = 0.377,95% CI:0.146-0.971,p = 0.043)(HR = 0.320,95% CI:0.116-0.879,p = 0.027):对于错过最佳PCI时间的急性STEMI患者,立即PCI并不能减少不良临床结局。
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来源期刊
CiteScore
0.90
自引率
14.30%
发文量
44
审稿时长
6-12 weeks
期刊介绍: Polish Journal of Thoracic and Cardiovascular Surgery is a quarterly aimed at cardiologists, cardiosurgeons and thoracic surgeons. Includes the original works (experimental, research and development), illustrative and casuistical works about cardiology and cardiosurgery.
期刊最新文献
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