The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospective cohort study
Abstract Background Early reperfusion of the coronary artery has become the first choice for patients with ST-segment elevation myocardial infarction (STEMI). How to deal with patients who miss the time window for early reperfusion is still controversial. Based on real-world data, this study was con...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2020-04-01
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| Series: | BMC Cardiovascular Disorders |
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| Online Access: | http://link.springer.com/article/10.1186/s12872-020-01479-0 |
| _version_ | 1828531571828719616 |
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| author | Qixin Guo Jinyu Huang Yong Shen Guoxin Tong Hong Li Shasha Meng |
| author_facet | Qixin Guo Jinyu Huang Yong Shen Guoxin Tong Hong Li Shasha Meng |
| author_sort | Qixin Guo |
| collection | DOAJ |
| description | Abstract Background Early reperfusion of the coronary artery has become the first choice for patients with ST-segment elevation myocardial infarction (STEMI). How to deal with patients who miss the time window for early reperfusion is still controversial. Based on real-world data, this study was conducted to explore whether percutaneous coronary intervention (PCI) has an advantage over standard drug therapy in patients who miss the optimal treatment window. Methods Consecutive patients who were diagnosed with STEMI and met the inclusion criteria between 2009 and 2018 in our center were retrospectively included in this cohort study. The primary endpoint events were major adverse cardiac events (MACEs), including heart failure, sudden cardiac death, malignant arrhythmia, thrombi and bleeding events during the period of admission. Secondary endpoint events were components of MACEs. At the same time, we also evaluated angina pectoris at admission and discharge through Canadian Cardiovascular Society (CCS) grading. Results This study enrolled 417 STEMI patients and divided them into four groups (PCI < 3 days, 14.87%; 3 days<PCI < 7 days, 21.104%; PCI > 7 days, 34.29%; MED, 29.74%). During the period of admission, MACEs occurred in 52 cases. The incidence of MACEs was 11.29, 7.95, 4.20 and 25.81% in the four respective groups (p < 0.0001). The MED group had higher rates of MACEs (OR = 3.074; 95% CI 0.1.116–8.469, p = 0.03) and cardiac death (OR = 3.027; 95% CI 1.121–8.169, p = 0.029) compared to the PCI group. Although both treatments were effective in improving CCS grade at discharge, the PCI group improved more significantly (p < 0.0001). Conclusions In the real world, delayed PCI can be more effective in patients with angina symptoms at discharge and reduce the incidence of MACEs and cardiac death during hospitalization. The timing of intervention was independent of the occurrence of MACEs during hospitalization and of improvement in symptoms. |
| first_indexed | 2024-12-11T22:40:37Z |
| format | Article |
| id | doaj.art-a032c86000f840a39098f917ab87b720 |
| institution | Directory Open Access Journal |
| issn | 1471-2261 |
| language | English |
| last_indexed | 2024-12-11T22:40:37Z |
| publishDate | 2020-04-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Cardiovascular Disorders |
| spelling | doaj.art-a032c86000f840a39098f917ab87b7202022-12-22T00:47:49ZengBMCBMC Cardiovascular Disorders1471-22612020-04-012011910.1186/s12872-020-01479-0The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospective cohort studyQixin Guo0Jinyu Huang1Yong Shen2Guoxin Tong3Hong Li4Shasha Meng5Nanjing Medical UniversityNanjing Medical UniversityZhejiang University of Traditional Chinese MedicineHangzhou First People’s HospitalHangzhou First People’s HospitalHangzhou First People’s HospitalAbstract Background Early reperfusion of the coronary artery has become the first choice for patients with ST-segment elevation myocardial infarction (STEMI). How to deal with patients who miss the time window for early reperfusion is still controversial. Based on real-world data, this study was conducted to explore whether percutaneous coronary intervention (PCI) has an advantage over standard drug therapy in patients who miss the optimal treatment window. Methods Consecutive patients who were diagnosed with STEMI and met the inclusion criteria between 2009 and 2018 in our center were retrospectively included in this cohort study. The primary endpoint events were major adverse cardiac events (MACEs), including heart failure, sudden cardiac death, malignant arrhythmia, thrombi and bleeding events during the period of admission. Secondary endpoint events were components of MACEs. At the same time, we also evaluated angina pectoris at admission and discharge through Canadian Cardiovascular Society (CCS) grading. Results This study enrolled 417 STEMI patients and divided them into four groups (PCI < 3 days, 14.87%; 3 days<PCI < 7 days, 21.104%; PCI > 7 days, 34.29%; MED, 29.74%). During the period of admission, MACEs occurred in 52 cases. The incidence of MACEs was 11.29, 7.95, 4.20 and 25.81% in the four respective groups (p < 0.0001). The MED group had higher rates of MACEs (OR = 3.074; 95% CI 0.1.116–8.469, p = 0.03) and cardiac death (OR = 3.027; 95% CI 1.121–8.169, p = 0.029) compared to the PCI group. Although both treatments were effective in improving CCS grade at discharge, the PCI group improved more significantly (p < 0.0001). Conclusions In the real world, delayed PCI can be more effective in patients with angina symptoms at discharge and reduce the incidence of MACEs and cardiac death during hospitalization. The timing of intervention was independent of the occurrence of MACEs during hospitalization and of improvement in symptoms.http://link.springer.com/article/10.1186/s12872-020-01479-0ST-segment elevation myocardial infarctionReperfusion therapyPercutaneous Transluminal coronary intervention |
| spellingShingle | Qixin Guo Jinyu Huang Yong Shen Guoxin Tong Hong Li Shasha Meng The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospective cohort study BMC Cardiovascular Disorders ST-segment elevation myocardial infarction Reperfusion therapy Percutaneous Transluminal coronary intervention |
| title | The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospective cohort study |
| title_full | The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospective cohort study |
| title_fullStr | The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospective cohort study |
| title_full_unstemmed | The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospective cohort study |
| title_short | The role of late reperfusion in ST-segment elevation myocardial infarction: a real-world retrospective cohort study |
| title_sort | role of late reperfusion in st segment elevation myocardial infarction a real world retrospective cohort study |
| topic | ST-segment elevation myocardial infarction Reperfusion therapy Percutaneous Transluminal coronary intervention |
| url | http://link.springer.com/article/10.1186/s12872-020-01479-0 |
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