P5567Treatment of late arrival ST-elevation myocardial infarction in a real world clinical survey

Abstract

Introduction: Although there are clear guidelines regarding the management of patients presenting with ST-Elevation Myocardial Infarction (STEMI) within twelve hours of symptom onset, the management beyond twelve hours (late arrival patients) remains controversial. We sought to evaluate trends in the management and outcome of these patients. Methods: We evaluated the management strategies, clinical characteristics, and all-cause mortality of STEMI patients arriving twelve hours after symptom onset, who were enrolled in a national survey between 2006 and 2016, excluding patients presenting with an unstable heart rhythm or in cardiogenic shock. Patients presenting with late arrival STEMI were divided on the basis of referral to coronary angiography (CA) during the index hospitalization. The primary endpoint of the study was the occurrence of all-cause mortality at 1-year of follow-up. Results: The study population comprised 287 patients with late arrival STEMI who were included in the survey, of whom 236 (82%) were referred to CA during the index hospitalization. Compared with patients not undergoing CA, those undergoing CA were younger (63 vs 71; p<0.001), had a higher BMI (27.6 vs 26.3; p=.04), and less chronic renal failure (7% vs 32%; p<0.001). During their hospital stay, they were less likely to suffer from a cerebral vascular accident (CVA) or transient ischemic attack (TIA) (2% vs 12%; p=0.002). Kaplan-Meier survival analysis showed that at 1-year of follow-up, mortality rates were significantly lower among patients who underwent CA (11.7%) vs. no CA (42.6%; p<0.001 for the overall difference during follow-up [Figure]). The survival benefit associated with CA remained consistent after further adjustment for comorbidities, including gender, age, smoking status, renal function, Killip class on presentation, and a previous CVA (hazard ratio, 0.2; 95% confidence interval, 0.09 to 0.44; p<0.001). Conclusion: Our findings suggest that patients presenting with late arrival STEMI should be referred to CA during the index hospitalization despite the delay in presentation.