Late Percutaneous Coronary Intervention is Associated with Better Prognosis of Patients with Acute Myocardial Infarction.

Abstract

BackgroundThe optimal timing of invasive coronary revascularization in patients with late presentation of acute myocardial infarction (AMI) remains unclear.ObjectiveThis study aimed to investigate whether late percutaneous coronary intervention (PCI) is associated with the prognosis of AMI patients with HFpEF presenting >24h after symptom onset.MethodsWe enrolled 680 AMI patients with HFpEF. Patients were divided into 3 groups: early-PCI strategy (defined as the time to open IRA from symptom onset <24 h), late-PCI strategy (defined as the time of PCI-mediated reperfusion was >24 h) and non-revascularization group.ResultsA total of 144 (21.2%) experienced a MACE, including 118 (17.4%) all-cause deaths and 26 (3.8%) re-hospitalization for HF during a follow-up period of 30.20±15.62 months. After adjusting for gender, age, smoking, diabetes mellitus, NT-proBNP and eGFR, late-PCI was a significant and independent predictor of MACE (hazard ratio 0.367; 95% confidence interval 0.202–0.665; p<0.001). Kaplan–Meier analysis showed that late-PCI decreased cumulative risk of MACE (p< 0.001).ConclusionLate-PCI and early-PCI strategies are associated with a reduced risk of MACE in AMI patients with HFpEF presenting >24 h after symptom onset, compared to conservative strategies.