Optimal management of patients with ST-segment elevation myocardial infarction with delayed admission to the percutaneous coronary intervention center (more than 12 hours)

Abstract

The success of myocardial infarction (MI) treatment largely depends on the timely delivery of quality health care, primarily on the blood flow restoration through the infarct-related artery. This review presents the results of several meta-analyzes and studies, including our own data, which indicate that delayed revascularization (>12 h from the onset) performed in patients with ST-segment elevation MI leads to an increase in the short- and long-term survival, a decrease in the incidence of cardiovascular events and severity of myocardial remodeling. For example, the analysis from the V. P. Polyakov Samara Regional Clinical Cardiological Dispensary showed the higher mortality rate in patients with ST-segment elevation MI admitted >12 hours from the onset, who received conservative treatment (7,9%) than in those with the invasive management (0,5%) (hazard ratio, 14,8; 95% confidence interval, 1,7- 124,7; P<0,05). However, at present, there is no complete clarity regarding the strategy of managing such patients. According to the current European Society of Cardiology guidelines on myocardial revascularization (2018), the class of recommendations reaches IIA, which means the conflicting data and/ or disagreement about usefulness/efficacy of a particular treatment method, but weight of evidence/opinion is in favor of usefulness/efficacy.

Keywords

• acute myocardial infarction
• st-segment elevation acute coronary syndrome
• percutaneous coronary intervention
• revascularization