Characteristics, management and outcome of patients with late-arrival STEMI in the Acute Coronary Syndrome Israeli Surveys (ACSIS)

• Published in: International journal of cardiology. Heart & vasculature 2024-08, Vol.53, p.101476, Article 101476
• Main Authors: Tarabih, Moataz, Ovdat, Tal, Karkabi, Basheer, Barel, Maguli S., Muhamad, Mahamid, Beigel, Roy, Orvin, Katia, Shiran, Avinoam, Eitan, Amnon
• Format: Article
• Language: English
• Subjects: Late arrival; Myocardial infarction; Outcomes; Percutaneous coronary intervention; ST elevation; TIMI flow
• ISSN: 2352-9067; 2352-9067
• DOI: 10.1016/j.ijcha.2024.101476

Patients with ST-elevation myocardial infarction (STEMI) and late arrival (>12 h) after symptom onset, are at high risk for mortality and heart failure and represent a challenge for management. We aimed to define patient characteristics, management, and outcome of late-arrival STEMI in Israel over the last 20 years. We analyzed data of late-arrival STEMI (12–48 h and > 48 h) from the biennial acute coronary syndrome Israeli Surveys (ACSIS), as well as time-dependent changes [early (2000–2010) Vs. late (2013–2021) period]. Data regarding time from symptom onset to hospital arrival was available in 6,466 STEMI patients. Of these, 9.6 % arrived 12–48 h and 3 % >48 h from symptom onset. Late-arrival patients were more likely to be older women with diabetes and high GRACE score and less likely to have prior myocardial infarction. In recent years, 95 % of patients arriving 12–48 h and 96 % of those arriving > 48 h had coronary angiography, as opposed to 75 % and 77 % in the early years (p = 0.007). Percutaneous coronary intervention (PCI) increased from 60 % and 55 % respectively to 85 % (p ≤ 0.001). TIMI-3 flow after primary PCI was 89–92 %, irrespective of arrival time. Late arrival patients (12–48 h but not > 48 h) who had PCI had better adjusted 1-year survival, HR 0.49 (95 %CI 0.29–0.82), p = 0.01. Late-arrival STEMI patients have higher risk characteristics. Most late-arrival patients undergo coronary angiography and PCI and have TIMI-3 flow after primary PCI. In patients arriving 12–48 h after symptom onset PCI is associated with better survival.