In-hospital management and intermediate term outcomes in stable patients with ST segment elevation myocardial infarction presenting between 12-48 hours of symptom onset versus 2-7 days after the onset of chest pain; a single center study

Objective: To evaluate hospital management, revascularisation and intermediate-term major adverse cardiac events amongst ST elevation myocardial infarction patients and to compare them in early and late presentations. Methods: The retrospective study was conducted at Tabba Heart Institute, Karachi, and comprised data from July 2013 to December 2016. ST elevation myocardial infarction patients presenting between 12-48 hours of symptom onset were designated as early-late, while those presenting 2-7 days after the onset of symptoms were designated as late-late. Data included related to patients admitted consecutively with >12hrs of chest pain without immediate reperfusion. Major adverse cardiac events were composite of death, re-myocardial infarction, need for revascularisation or heart failure. SPSS 19 was used for data analysis. Results: Out of 234, patients, 110(47%) were early-late and 124(53%) were late-late. Overall mean age was 58.5 +/- 12.2years, and 188( 80.3%) subjects were men. Anterior all myocardial infarction was in 134(57.3%) cases. Non-invasive assessment for ischaemia/viability was performed in 96(41%) cases and angiography in 196(83.8%). Early-late were revascularised more frequently 53(48.2%) than late-late 49(39.5%) (p>0.05). Median follow-up was 23 months (interquartile range: 13-34 months). Major adverse cardiac events occurred in 45(19.6%) patients but there was no significant difference between earlylate and late-late patients (p>0.05). Conclusion: Revascularisation was found to have favourable impact on intermediate-term adverse cardiac events.