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Early versus late delayed percutaneous coronary intervention in elderly patients with ST-segment elevation myocardial infarction

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Abstract

Background and objective

There are a substantial proportion of elderly patients with ST-segment elevation myocardial infarction (STEMI) miss the optimal time window (12 h from symptom onset) of primary percutaneous coronary intervention (PCI). For these patients, the ideal timing of delayed PCI remains undetermined. Therefore, this study compared the clinical outcomes of early versus late delayed PCI in elderly patients with STEMI.

Methods

From January 2014 to September 2019, 512 patients aged ≥ 65 years with STEMI who underwent delayed PCI after 12 h from symptom onset were included and then categorized into the early PCI group (12–48 h, n = 111) and late PCI group (48 h-28 days, n = 401) according to the timing of delayed PCI. Propensity score matching (PSM) was conducted to adjust the confounding factors between groups. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), a composite of all-cause death, cardiac death, recurrent myocardial infarction (MI), stroke, and ischemia-driven revascularization.

Results

During a mean follow-up of 77 months, 163 (31.8%) patients developed MACCE and 93 (18.2%) died. Early or late delayed PCI did not make a significant difference in clinical outcomes of MACCE (Before PSM: HR 0.773, 95% CI 0.520–1.149, P = 0.203; After PSM: HR 0.869, 95% CI 0.498–1.517, P = 0.622), all-cause death, cardiac death, recurrent MI, stroke, and ischemia-driven revascularization in both overall patients and the PSM cohorts.

Conclusion

Early delayed PCI (12–48 h from symptom onset), for elderly patients with STEMI who present > 12 h after symptom onset is not associated with better long-term clinical outcomes compared with late delayed PCI (48 h-28 days).

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Data availability

The authors are responsible for the raw data of this study without any undue reservation.

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Acknowledgements

We sincerely thank all the patients and investigators who participated in this study.

Funding

This study was supported by Tianjin Key Medical Discipline (Specialty) Construction Project.

Author information

Author notes

  1. Jiachun Lang and Chen Wang have contributed equally to this work and share first authorship.

Authors and Affiliations

  1. Clinical School of Thoracic, Tianjin Medical University, Tianjin, China

    Jiachun Lang, Chen Wang, Rongdi Xu, Jikun Wu & Hongliang Cong

  2. Department of Cardiology, Tianjin Chest Hospital, Tianjin, China

    Jiachun Lang, Chen Wang, Jingxia Zhang, Yuecheng Hu, Lin Wang, Yin Liu, Rongdi Xu, Jikun Wu, Wei Qi, Chunwei Liu, Wenyu Li, Tingting Li, Dongxia Jin, Ao Wei, Le Wang & Hongliang Cong

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  1. Jiachun Lang
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Contributions

JL, CW, LW, HC, and YL designed the study. JL, JZ, YH, LW, RX, and JW collected the clinical data. JL, WQ, CL, WL, TL, DJ, and AW performed the statistical analyses. JL and CW drafted the manuscript. All authors contributed to the present study and approved the submitted manuscript.

Corresponding authors

Correspondence to Le Wang or Hongliang Cong.

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Conflict of interest

The authors declare that they have no competing interests.

Ethics and consent to participate

Research protocol of the patients was reviewed and authorized by the Tianjin Chest Hospital Ethical Committee. Written informed consent of patients was waived by the ethics committee.

Research involving human and animal rights

This study was conducted following the Declaration of Helsinki and was approved by the Tianjin Chest Hospital Ethical Committee. All patient data were analyzed in anonymity. Patient consent was waived by the ethics committee, as no individual data were published, nor was any intervention.

Informed consent

The research protocol was reviewed and authorized by the Tianjin Chest Hospital Ethical Committee, which waived the requirement for written informed consent.

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Lang, J., Wang, C., Zhang, J. et al. Early versus late delayed percutaneous coronary intervention in elderly patients with ST-segment elevation myocardial infarction. Aging Clin Exp Res 35, 1317–1324 (2023). https://doi.org/10.1007/s40520-023-02417-8

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  • DOI: https://doi.org/10.1007/s40520-023-02417-8

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