Open AccessLate Percutaneous Coronary Intervention Prevents Left Ventricular Remodeling and Improves Clinical Outcomes in Patients With ST ‐Elevation Myocardial Infarction
Author(s) -
Fan Yan,
Bai Xiaojun,
Chen Yuewu,
Shen Guidong,
Lu Qun,
Wan Zhaofei,
Zhou Dong,
Shen Yuan,
Ma Aiqun
Publication year - 2015
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.22356
Subject(s) - medicine , mace , percutaneous coronary intervention , conventional pci , cardiology , myocardial infarction , hazard ratio , heart failure , ventricular remodeling , proportional hazards model , confidence interval , odds ratio
Background The optimal strategy for treating late presenters of ST ‐elevation myocardial infarction ( STEMI ) remains uncertain. Hypothesis percutaneous coronary intervention ( PCI ) has a favorable effect on left ventricular ( LV ) remodeling and clinical outcomes in late presenters of STEMI . Methods Patients with STEMI who were hospitalized between 2009 and 2011 at 7 PCI ‐capable hospitals in China were selected. Cardiac characteristics were reassessed by echocardiography between August 2013 and January 2014. The clinical endpoints were evaluated during a median follow‐up period of 36 months. Results 1090 patients who either underwent late PCI (n = 786) or received standard medical therapy alone (n = 304) was analyzed. Left ventricular remodeling was more pronounced in the conservative‐treatment group. Logistic regression revealed that late PCI was independently and negatively correlated with LV remodeling (odds ratio: 0.356, 95% confidence interval [ CI ]: 0.251‐0.505, P < 0.001). Kaplan‐Meier analysis showed the lower risks of major adverse cardiovascular events ( MACE ), all‐cause death, and rehospitalization for heart failure in the late‐ PCI group. Multivariate Cox regression revealed that late PCI was significantly associated with lower risks for MACE , all‐cause death, and rehospitalization for heart failure both in all patients (hazard ratio [ HR ]: 0.507, 95% CI : 0.412‐0.625, P < 0.001; HR : 0.419, 95% CI : 0.314‐0.559, P < 0.001; and HR : 0.583, 95% CI : 0.379‐0.896, P = 0.014, respectively) and in the matched patients ( HR : 0.466, 95% CI : 0.358‐0.607, P < 0.001; HR : 0.398, 95% CI : 0.277‐0.571, P < 0.001; and HR : 0.498, 95% CI : 0.283‐0.878, P = 0.016, respectively) by propensity‐score analysis. Conclusions Late‐ PCI strategy prevents LV remodeling and improves clinical outcomes in STEMI patients compared with conservative strategies.