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Cited 21 time in webofscience Cited 29 time in scopus
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Long-Term Outcomes of Patients With Late Presentation of ST-Segment Elevation Myocardial Infarctionopen access

Authors
Cho, Kyung HoonHan, XiongyiAhn, Joon HoHyun, Dae YoungKim, Min ChulSim, Doo SunHong, Young JoonKim, Ju HanAhn, YoungkeunHwang, Jin YongOh, Seok KyuCha, Kwang SooChoi, Cheol UngHwang, Kyung-KukGwon, Hyeon CheolJeong, Myung Ho
Issue Date
20-Apr-2021
Publisher
ELSEVIER SCIENCE INC
Keywords
percutaneous coronary; intervention; registries; Republic of Korea; ST-segment elevation myocardial infarction
Citation
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, v.77, no.15, pp.1859 - 1870
Indexed
SCIE
SCOPUS
Journal Title
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY
Volume
77
Number
15
Start Page
1859
End Page
1870
URI
https://scholarworks.bwise.kr/gnu/handle/sw.gnu/3832
DOI
10.1016/j.jacc.2021.02.041
ISSN
0735-1097
Abstract
BACKGROUND Real-world data on baseline characteristics, clinical practice, and outcomes of late presentation (12 to 48 h of symptom onset) in patients with ST-segment elevation myocardial infarction (STEMI) are limited. OBJECTIVES This study aimed to investigate real-world features of STEMI late presenters in the contemporary percutaneous coronary intervention (PCI) era. METHODS Of 13,707 patients from the Korea Acute Myocardial Infarction Registry-National Institutes of Health database, 5,826 consecutive patients diagnosed with STEMI within 48 h of symptom onset during 2011 to 2015 were categorized as late (12 to 48 h; n = 624) or early (< 12 h; n = 5,202) presenters. Coprimary outcomes were 180-day and 3-year all-cause mortality. RESULTS Late presenters had remarkably worse clinical outcomes than early presenters (180-day mortality: 10.7% vs. 6.8%; 3-year mortality: 16.2% vs. 10.6%; both log-rank p < 0.001), whereas presentation at $12 h of symptom onset was not independently associated with increased mortality after STEMI. The use of invasive interventional procedures abruptly decreased from the first (< 12 h) to the second (12 to 24 h) 12-h interval of symptom-to-door time ("no primary PCI strategy" increased from 4.9% to 12.4%, and 'no PCI" from 2.3% to 6.6%; both p < 0.001). Mortality rates abruptly increased from the first to the second 12-h interval of symptom-to-door time (from 6.8% to 11.2% for 180-day mortality; from 10.6% to 17.3% for 3-year mortality; all p < 0.05). CONCLUSIONS Data from a nationwide prospective Korean registry reveal that inverse steep differences in the use of invasive interventional procedures and mortality rates were found between early and late presenters after STEMI. A multidisciplinary approach is required in identifying late presenters of STEMI who can benefit from invasive interventional procedures until further studied. (J Am Coll Cardiol 2021;77:1859-70) (c) 2021 by the American College of Cardiology Foundation.
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