Characteristics, in-hospital management and outcome of late acute ST-elevation myocardial infarction presenters
Patients with delayed presentation of acute myocardial infarction with ST-segment elevation (STEMI) frequently have a poor prognosis but literature about acute complications in intensive cardiac care unit (ICCU) and in-hospital outcome are still limited.Methods
All STEMI patients admitted to our institution between June 2007 and December 2013 were divided into patients presenting more than 12 h after symptom onset (lateSTEMI) and within 12 h (STEMI). Baselines clinical features including details about treatment of choice were collected. Major acute complications in ICCU and in-hospital mortality were the main end-points.Results
A total of 1372 patients were included, 147 (10.8%) were lateSTEMI. In ICCU lateSTEMI patients compared with STEMI patients experienced more frequently heart failure (75, 51.2% vs. 298, 24.3%; P < 0.001), atrial fibrillation (26, 17.7% vs. 130, 10.6%; P = 0.011), complete atrioventricular block (16, 10.9% vs. 63, 5.1%; P = 0.005), stroke (5, 3.4% vs. 5, 0.4%; P < 0.001), myocardial rupture (6, 4.1% vs. 3, 0.2%; P < 0.001), with higher administration of noninvasive ventilation support therapy (13, 9.8% vs. 44, 3.6%; P = 0.001) and the intra-aortic balloon counter-pulsation use (14, 10.3% vs. 102, 8.3%; P = 0.038). Intrahospital mortality was significantly higher in the lateSTEMI group (19, 13.4% vs. 69, 5.6%; P = 0.001). At the multiple regression analysis age [odds ratio (OR) 2.2 (1.46–2.92.; P = 0.01)], diabetes [OR 2.37 (1.38–4.07); P = 0.002] intra-aortic balloon counter-pulsation implantation [OR 2.78 (1.30–5.9); P = 0.03] and late presentation more than 12 h [2.52 (1.35–4.69); P = 0.001] resulted independently correlated with in-hospital mortality while a successful percutaneous coronary intervention procedure was protective [OR 0.15 (0.08–0.27); P = 0.003; all 95% confidence interval).Conclusion
Late presenters STEMI patients present a worse risk profile and prognosis compared with patients who arrive less than 12 h from onset of symptoms. Because of the presence of serious complications such as heart rupture or stroke a careful clinic and echocardiographic monitoring is strongly advisable in these population.