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Long-Term Outcomes of Patients With Late Presentation of ST-Segment Elevation Myocardial Infarction
- Source :
- Journal of the American College of Cardiology. 77(15)
- Publication Year :
- 2020
-
Abstract
- Real-world data on baseline characteristics, clinical practice, and outcomes of late presentation (12 to 48 h of symptom onset) in patients with ST-segment elevation myocardial infarction (STEMI) are limited.This study aimed to investigate real-world features of STEMI late presenters in the contemporary percutaneous coronary intervention (PCI) era.Of 13,707 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health database, 5,826 consecutive patients diagnosed with STEMI within 48 h of symptom onset during 2011 to 2015 were categorized as late (12 to 48 h; n = 624) or early (12 h; n = 5,202) presenters. Coprimary outcomes were 180-day and 3-year all-cause mortality.Late presenters had remarkably worse clinical outcomes than early presenters (180-day mortality: 10.7% vs. 6.8%; 3-year mortality: 16.2% vs. 10.6%; both log-rank p 0.001), whereas presentation at ≥12 h of symptom onset was not independently associated with increased mortality after STEMI. The use of invasive interventional procedures abruptly decreased from the first (12 h) to the second (12 to 24 h) 12-h interval of symptom-to-door time ("no primary PCI strategy" increased from 4.9% to 12.4%, and "no PCI" from 2.3% to 6.6%; both p0.001). Mortality rates abruptly increased from the first to the second 12-h interval of symptom-to-door time (from 6.8% to 11.2% for 180-day mortality; from 10.6% to 17.3% for 3-year mortality; all p 0.05).Data from a nationwide prospective Korean registry reveal that inverse steep differences in the use of invasive interventional procedures and mortality rates were found between early and late presenters after STEMI. A multidisciplinary approach is required in identifying late presenters of STEMI who can benefit from invasive interventional procedures until further studied.
- Subjects :
- Male
medicine.medical_specialty
Delayed Diagnosis
Time Factors
medicine.medical_treatment
030204 cardiovascular system & hematology
Time-to-Treatment
Late presentation
03 medical and health sciences
0302 clinical medicine
Percutaneous Coronary Intervention
Internal medicine
Republic of Korea
medicine
Long term outcomes
ST segment
Humans
In patient
cardiovascular diseases
030212 general & internal medicine
Myocardial infarction
Registries
Aged
business.industry
Mortality rate
Percutaneous coronary intervention
Middle Aged
medicine.disease
Treatment Outcome
Conventional PCI
ST Elevation Myocardial Infarction
Female
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- ISSN :
- 15583597
- Volume :
- 77
- Issue :
- 15
- Database :
- OpenAIRE
- Journal :
- Journal of the American College of Cardiology
- Accession number :
- edsair.doi.dedup.....fecc6eeccd9706dee45a098504962d16