At the outer edge of STEMI time: even after 12 hours, the clock keeps ticking

Abstract Introduction Although primary percutaneous coronary intervention (pPCI) is not a class I recommendation in all patients (pts) presenting within 12 to 48h of symptom onset (late ST-segment Elevation Myocardial Infarction, STEMI), there increasing evidence supporting its routine use this population. Data on long-term clinical outcomes sparse. Objective To evaluate MACE late-STEMI pts submitted pPCI and compare with early reperfusion groups. Methods Retrospective analysis consecutive due STEMI between 2010 2015 centre. Included were stratified 5 groups according symptom-to-balloon time (SBT): <3h; 3–6h; 6–12h; 12–24h; 24–48h. Of total 903 pts, 19 excluded SBT >48h. Long-term events established as 5y mortality 5y-MACE (a composite endpoint death, re-infarction, heart failure hospital admission ischemic stroke). The cumulative incidence was calculated by the Cox regression presented Kaplan-Meier method. Results 884 included study, stratification was: pPCI<3h (47.4%), 3–6h (24.9%), 6–12h (16.5%), 12–24h (8.0%), 24–48h (3.2%). These showed no significant difference terms demographic characteristics (age, CV risk factors, previous disease or failure), severity (systolic arterial pressure, Killip-Kimball class, left ventricle ejection fraction) angiography findings (multivessel disease, complete revascularization PCI success). After median follow-up 76 (56; 98) months, 5-year 20.6% (182 pts) 23.3% (206 pts). associated increased SBT: 5.0 (2.0; 9.0) hours vs 4.0 6.5) hours, p<0.001. components, only that association higher mortality: 10.0) 6.0), Differences when considering (Figure 1). Conclusions As expected, benefit for cardiovascular events. Within group, seems be clear distinction pPCI<24h >24h, although timing most probably acts continuum. Funding Acknowledgement Type funding sources: None.