Percutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI

Frédéric Bouisset (1, 2) , Edouard Gerbaud (3) , Vincent Bataille (1, 2) , Pierre Coste (3) , Etienne Puymirat (4) , Loic Belle (5) , Clément Delmas (1, 2) , Guillaume Cayla (6) , Pascal Motreff (7, 8) , Gilles Lemesle (9) , Nadia Aissaoui (10) , Didier Blanchard , François Schiele (11) , Tabassome Simon (12, 13) , Nicolas Danchin (4) , Jean Ferrières (1, 2)

1 CERPOP - Centre d'Epidémiologie et de Recherche en santé des POPulations
2 Service Cardiologie [CHU Toulouse]
3 Hôpital Haut-Lévêque [CHU Bordeaux]
4 PARCC (UMR_S 970/ U970) - Paris-Centre de Recherche Cardiovasculaire
5 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
6 CHU Nîmes - Centre Hospitalier Universitaire de Nîmes
7 Service de Cardiologie Maladies Vasculaires [CHU Clermont-Ferrand]
8 ISIT - Image Science for Interventional Techniques
9 CHRU Lille - Centre Hospitalier Régional Universitaire [CHU Lille]
10 HEGP - Hôpital Européen Georges Pompidou [APHP]
11 Service de cardiologie [CHRU de Besançon]
12 UPMC - Université Pierre et Marie Curie - Paris 6 - UFR de Médecine Pierre et Marie Curie
13 LBPC (U698) - Hémostase, bio-ingénierie et remodelage cardiovasculaires

Background: The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) presenting late->12 hours following symptom onset-is still under debate. Objectives: The purpose of this study was to describe characteristics, temporal trends, and impact of revascularization in a large population of latecomer STEMI patients. Methods: The authors analyzed the data of 3 nationwide observational studies from the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) program, conducted over a 1-month period in 2005, 2010, and 2015. Patients presenting between 12 and 48 hours after symptom onset were classified as latecomers. Results: A total of 6,273 STEMI patients were included in the 3 cohorts, 1,169 (18.6%) of whom were latecomers. After exclusion of patients treated with fibrinolysis and patients deceased within 2 days after admission, 1,077 patients were analyzed, of whom 729 (67.7%) were revascularized within 48 hours after hospital admission. At 30-day follow-up, all-cause death rate was significantly lower among revascularized latecomers (2.1% vs 7.2%; P < 0.001). After a median follow-up of 58 months, the rate of all-cause death was 30.4 (95% CI: 25.7-35.9) per 1,000 patient-years in the revascularized latecomers group vs 78.7 (95% CI: 67.2-92.3) per 1,000 patient-years in the nonrevascularized latecomers group (P < 0.001). In multivariate analysis, revascularization of latecomer STEMI patients was independently associated with a significant reduction of mortality occurrence during follow-up (HR: 0.65 [95% CI: 0.50-0.84]; P = 0.001). Conclusions: Coronary revascularization of latecomer STEMI patients is associated with better short and long-term clinical outcomes.

Mots clés: Acute coronary syndrome; Acute myocardial infarction; Immortal time bias; Latecomer; Percutaneous coronary revascularization

Domaines: Cardiologie et système cardiovasculaire

Frédéric Bouisset, Edouard Gerbaud, Vincent Bataille, Pierre Coste, Etienne Puymirat, et al.. Percutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI. Journal of the American College of Cardiology, 2021, 78 (13), pp.1291-1305. ⟨10.1016/j.jacc.2021.07.039⟩. ⟨hal-03626432⟩