Treatment of Late Arrival STEMI in a Real World Israeli Clinical Survey

Objective

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 the Acute Coronary Syndrome Israeli Survey (ACSIS) 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 (62.7 vs 71.4, p=0.001), had a higher BMI (27.6 vs 26.3, p=.04), and less chronic renal failure (7.2% vs 32.0%, p=0.001). During their hospital stay, they were less likely to develop acute renal failure (3.9% vs 12.4%, p=0.013) and had a lower combined incidence of any form of heart failure (16% vs 26.7%, p=0.044). 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

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.