Characteristics, in-hospital management and outcome of late acute ST-elevation myocardial infarction presenters

BackgroundPatients with delayed presentation of acute myocardial infarction with ST-segment elevation (STEMI) frequently have a poor prognosis but literature about acute complications in intensive cardiac care unit (ICCU) and in-hospital outcome are still limited.MethodsAll STEMI patients admitted to our institution between June 2007 and December 2013 were divided into patients presenting more than 12h after symptom onset (lateSTEMI) and within 12h (STEMI). Baselines clinical features including details about treatment of choice were collected. Major acute complications in ICCU and in-hospital mortality were the main end-points.ResultsA total of 1372 patients were included, 147 (10.8%) were lateSTEMI. In ICCU lateSTEMI patients compared with STEMI patients experienced more frequently heart failure (75, 51.2% vs. 298, 24.3%; P<0.001), atrial fibrillation (26, 17.7% vs. 130, 10.6%; P=0.011), complete atrioventricular block (16, 10.9% vs. 63, 5.1%; P=0.005), stroke (5, 3.4% vs. 5, 0.4%; P<0.001), myocardial rupture (6, 4.1% vs. 3, 0.2%; P<0.001), with higher administration of noninvasive ventilation support therapy (13, 9.8% vs. 44, 3.6%; P=0.001) and the intra-aortic balloon counter-pulsation use (14, 10.3% vs. 102, 8.3%; P=0.038). Intrahospital mortality was significantly higher in the lateSTEMI group (19, 13.4% vs. 69, 5.6%; P=0.001). At the multiple regression analysis age [odds ratio (OR) 2.2 (1.46-2.92.; P=0.01)], diabetes [OR 2.37 (1.38-4.07); P=0.002] intra-aortic balloon counter-pulsation implantation [OR 2.78 (1.30-5.9); P=0.03] and late presentation more than 12h [2.52 (1.35-4.69); P=0.001] resulted independently correlated with in-hospital mortality while a successful percutaneous coronary intervention procedure was protective [OR 0.15 (0.08-0.27); P=0.003; all 95% confidence interval).ConclusionLate presenters STEMI patients present a worse risk profile and prognosis compared with patients who arrive less than 12h from onset of symptoms. Because of the presence of serious complications such as heart rupture or stroke a careful clinic and echocardiographic monitoring is strongly advisable in these population.