Long-Term Outcomes of Patients With Late Presentation of ST-Segment Elevation Myocardial Infarction
- Authors
- Cho, K.H.; Han, X.; Ahn, J.H.; Hyun, D.Y.; Kim, M.C.; Sim, D.S.; Hong, Y.J.; Kim, J.H.; Ahn, Y.; Hwang, J.Y.; Oh, S.K.; Cha, K.S.; Choi, C.U.; Hwang, K.-K.; Gwon, H.C.; Jeong, M.H.; KAMIR-NIH Investigators
- Issue Date
- 20-Apr-2021
- Publisher
- Elsevier Inc.
- Keywords
- percutaneous coronary intervention; registries; Republic of Korea; ST-segment elevation myocardial infarction
- Citation
- Journal of the American College of Cardiology, v.77, no.15, pp 1859 - 1870
- Pages
- 12
- Indexed
- SCIE
SCOPUS
- Journal Title
- Journal of the American College of Cardiology
- Volume
- 77
- Number
- 15
- Start Page
- 1859
- End Page
- 1870
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2020.sw.kumedicine/52986
- DOI
- 10.1016/j.jacc.2021.02.041
- ISSN
- 0735-1097
1558-3597
- Abstract
- 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. © 2021 American College of Cardiology Foundation
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Collections - 2. Clinical Science > Department of Cardiology > 1. Journal Articles
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