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Lang J, Wang C, Zhang J, Hu Y, Wang L, Liu Y, Xu R, Wu J, Qi W, Liu C, Li W, Li T, Jin D, Wei A, Wang L, Cong H. Early versus late delayed percutaneous coronary intervention in elderly patients with ST-segment elevation myocardial infarction. Aging Clin Exp Res 2023; 35:1317-1324. [PMID: 37171538 DOI: 10.1007/s40520-023-02417-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 04/14/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND AND OBJECTIVE There are a substantial proportion of elderly patients with ST-segment elevation myocardial infarction (STEMI) miss the optimal time window (12 h from symptom onset) of primary percutaneous coronary intervention (PCI). For these patients, the ideal timing of delayed PCI remains undetermined. Therefore, this study compared the clinical outcomes of early versus late delayed PCI in elderly patients with STEMI. METHODS From January 2014 to September 2019, 512 patients aged ≥ 65 years with STEMI who underwent delayed PCI after 12 h from symptom onset were included and then categorized into the early PCI group (12-48 h, n = 111) and late PCI group (48 h-28 days, n = 401) according to the timing of delayed PCI. Propensity score matching (PSM) was conducted to adjust the confounding factors between groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction (MI), stroke, and ischemia-driven revascularization. RESULTS During a mean follow-up of 77 months, 163 (31.8%) patients developed MACCE and 93 (18.2%) died. Early or late delayed PCI did not make a significant difference in clinical outcomes of MACCE (Before PSM: HR 0.773, 95% CI 0.520-1.149, P = 0.203; After PSM: HR 0.869, 95% CI 0.498-1.517, P = 0.622), all-cause death, cardiac death, recurrent MI, stroke, and ischemia-driven revascularization in both overall patients and the PSM cohorts. CONCLUSION Early delayed PCI (12-48 h from symptom onset), for elderly patients with STEMI who present > 12 h after symptom onset is not associated with better long-term clinical outcomes compared with late delayed PCI (48 h-28 days).
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Affiliation(s)
- Jiachun Lang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chen Wang
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jingxia Zhang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yuecheng Hu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Lin Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Yin Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Rongdi Xu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Jikun Wu
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wei Qi
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Chunwei Liu
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Wenyu Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Tingting Li
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Dongxia Jin
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Ao Wei
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China
| | - Le Wang
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
| | - Hongliang Cong
- Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
- Department of Cardiology, Tianjin Chest Hospital, Tianjin, China.
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Xue YL, Ma YT, Gao YP, Zhang SX, Su QY, Li YF, Zhang L, Ding PF, Li XW. Long-term outcomes of delayed percutaneous coronary intervention for patients with ST-segment elevation myocardial infarction: A propensity score-matched retrospective study. Medicine (Baltimore) 2021; 100:e27474. [PMID: 34797274 PMCID: PMC8601350 DOI: 10.1097/md.0000000000027474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/18/2021] [Indexed: 01/05/2023] Open
Abstract
The best time window of percutaneous coronary intervention (PCI) is within 12 hours for ST-segment elevation myocardial infarction (STEMI). However, there is limited evidence about the proper time of PCI for delayed STEMI patients.From June 2014 to June 2015, a total of 268 patients receiving PCI with second-generation drug-eluting stent in a Chinese hospital after 3 days of STEMI onset were enrolled in this retrospective study, who were divided into the early group (3-14 days) and the late group (>14 days). A propensity score match was conducted to reduce the baseline difference. The primary endpoint of all-cause death and secondary endpoints of major adverse cardiac and cerebrovascular event (myocardial infarction [MI], stroke, emergent revascularization, and rehospitalization due to heart failure) were compared using survival analysis.At last, 182 cases were matched after propensity score match, with no statistical difference in baseline characteristics and PCI data. Kaplan-Meier survival curve demonstrated no difference in all-cause death of the 2 groups (P = .512). However, the early group presented a higher incidence of MI than the late group (P = .036). The multivariate Cox regression analysis also demonstrated that the early PCI was an independent risk factor for MI compared with late PCI (hazard ratio = 3.83, 95%CI [1.91-8.82], P = .001). There was no statistical difference in other major adverse cardiac and cerebrovascular event, including stroke, emergent revascularization, and rehospitalization due to heart failure.Using the 2nd drug-eluting stent, early PCI (3-14 days) and late PCI (>14 days) have comparable efficacy and outcomes. However, patients receiving early PCI are subjected to a relatively higher risk of recurrent MI.
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Affiliation(s)
- Yu-Long Xue
- Department of Cardiovascular Medicine, Shanxi Dayi Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yue-Teng Ma
- Department of Cardiovascular Medicine, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yu-Ping Gao
- Department of Cardiovascular Medicine, Shanxi Dayi Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Sheng-Xiao Zhang
- Department of Rheumatology, the Second Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Qin-Yi Su
- Department of Second Clinical Medicine, Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Yu-Feng Li
- Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China
| | - Lei Zhang
- Department of Cardiovascular Medicine, Shanxi Dayi Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Peng-Fei Ding
- Department of Cardiovascular Medicine, Shanxi Dayi Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Xue-Wen Li
- Department of Cardiovascular Medicine, Shanxi Dayi Hospital Affiliated to Shanxi Medical University, Taiyuan, Shanxi Province, China
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