Long-Term Outcomes of Patients With Late Presentation of ST-Segment Elevation Myocardial Infarction

被引：54

作者：

Cho, Kyung Hoon ^{[1
]}

Han, Xiongyi ^{[1
]}

Ahn, Joon Ho ^{[1
]}

Hyun, Dae Young ^{[1
]}

Kim, Min Chul ^{[1
,2
]}

Sim, Doo Sun ^{[1
,2
]}

Hong, Young Joon ^{[1
,2
]}

Kim, Ju Han ^{[1
,2
]}

Ahn, Youngkeun ^{[1
,2
]}

Hwang, Jin Yong ^{[3
]}

Oh, Seok Kyu ^{[4
]}

Cha, Kwang Soo ^{[5
]}

Choi, Cheol Ung ^{[6
]}

Hwang, Kyung-Kuk ^{[7
]}

Gwon, Hyeon Cheol ^{[8
]}

Jeong, Myung Ho ^{[1
,2
]}

机构：

[1] Chonnam Natl Univ Hosp, Dept Cardiol, Gwangju, South Korea

[2] Chonnam Natl Univ, Med Sch, Dept Cardiol, Gwangju, South Korea

[3] Gyeongsang Natl Univ, Sch Med, Dept Cardiol, Jinju, South Korea

[4] Wonkwang Univ Hosp, Dept Cardiol, Iksan, South Korea

[5] Pusan Natl Univ Hosp, Dept Cardiol, Busan, South Korea

[6] Korea Univ, Dept Cardiol, Guro Hosp, Seoul, South Korea

[7] Chungbuk Natl Univ Hosp, Dept Cardiol, Cheongju, South Korea

[8] Seoul Samsung Med Ctr, Dept Cardiol, Seoul, South Korea

来源：

JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY | 2021年 / 77卷 / 15期

关键词：

percutaneous coronary; intervention; registries; Republic of Korea; ST-segment elevation myocardial infarction; MECHANICAL REPERFUSION; SYMPTOM-ONSET; SALVAGE; ANGIOPLASTY; MORTALITY; TIME;

D O I：

10.1016/j.jacc.2021.02.041

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

BACKGROUND 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. OBJECTIVES This study aimed to investigate real-world features of STEMI late presenters in the contemporary percutaneous coronary intervention (PCI) era. METHODS 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. RESULTS 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 p < 0.001). 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). CONCLUSIONS 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. (J Am Coll Cardiol 2021;77:1859-70) (c) 2021 by the American College of Cardiology Foundation.

引用

页码：1859 / 1870

页数：12

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