Late Percutaneous Coronary Intervention Prevents Left Ventricular Remodeling and Improves Clinical Outcomes in Patients With ST‐Elevation Myocardial Infarction

Abstract

Background

The optimal strategy for treating late presenters of ST‐elevation myocardial infarction ( STEMI) remains uncertain.

Hypothesis

percutaneous coronary intervention ( PCI) has a favorable effect on left ventricular ( LV) remodeling and clinical outcomes in late presenters of STEMI.

Methods

Patients with STEMI who were hospitalized between 2009 and 2011 at 7 PCI‐capable hospitals in China were selected. Cardiac characteristics were reassessed by echocardiography between August 2013 and January 2014. The clinical endpoints were evaluated during a median follow‐up period of 36 months.

Results

1090 patients who either underwent late PCI (n = 786) or received standard medical therapy alone (n = 304) was analyzed. Left ventricular remodeling was more pronounced in the conservative‐treatment group. Logistic regression revealed that late PCI was independently and negatively correlated with LV remodeling (odds ratio: 0.356, 95% confidence interval [ CI]: 0.251‐0.505, P < 0.001). Kaplan‐Meier analysis showed the lower risks of major adverse cardiovascular events ( MACE), all‐cause death, and rehospitalization for heart failure in the late‐ PCI group. Multivariate Cox regression revealed that late PCI was significantly associated with lower risks for MACE, all‐cause death, and rehospitalization for heart failure both in all patients (hazard ratio [ HR]: 0.507, 95% CI: 0.412‐0.625, P < 0.001; HR: 0.419, 95% CI: 0.314‐0.559, P < 0.001; and HR: 0.583, 95% CI: 0.379‐0.896, P = 0.014, respectively) and in the matched patients ( HR: 0.466, 95% CI: 0.358‐0.607, P < 0.001; HR: 0.398, 95% CI: 0.277‐0.571, P < 0.001; and HR: 0.498, 95% CI: 0.283‐0.878, P = 0.016, respectively) by propensity‐score analysis.

Conclusions

Late‐ PCI strategy prevents LV remodeling and improves clinical outcomes in STEMI patients compared with conservative strategies.