Percutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI

Abstract Background The optimal management of patients with ST-segment elevation myocardial infarction (STEMI) presenting late—>12 hours following symptom onset—is still under debate. Objectives The purpose of this study was to describe characteristics, temporal trends, and impact of revascularization in a large population of latecomer STEMI patients. Methods The authors analyzed the data of 3 nationwide observational studies from the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) program, conducted over a 1-month period in 2005, 2010, and 2015. Patients presenting between 12 and 48 hours after symptom onset were classified as latecomers. Results A total of 6,273 STEMI patients were included in the 3 cohorts, 1,169 (18.6%) of whom were latecomers. After exclusion of patients treated with fibrinolysis and patients deceased within 2 days after admission, 1,077 patients were analyzed, of whom 729 (67.7%) were revascularized within 48 hours after hospital admission. At 30-day follow-up, all-cause death rate was significantly lower among revascularized latecomers (2.1% vs 7.2%; P  Conclusions Coronary revascularization of latecomer STEMI patients is associated with better short and long-term clinical outcomes.