Optimal timing of delayed percutaneous coronary intervention in stable patients with ST-segment elevation myocardial infarction

Background There is ongoing controversy and limited data about the optimal timing to perform delayed percutaneous coronary intervention (PCI) in stable ST-segment elevation myocardial infarction (STEMI) patients who have missed opportunities for acute reperfusion therapy and are in absence of ongoing ischemia. Purpose To evaluate the effects of timing of delayed PCI on short- and long-term safety outcomes in stable STEMI patients. Methods A cohort of 3,048 stable STEMI patients without acute reperfusion therapy who underwent delayed PCI were included in the study. Procedural timing was stratified into three groups: <3d, 3–7d, >7d. Primary outcomes were 30-day and 12-month major adverse cardiac events (MACE), a composite of death and reinfarction. Multivariate logistic and Cox regression models were performed. Results After multivariate adjustment, restricted cubic splines revealed a monotonic decrease in the risk of MACE with prolonged procedural timing (Figure-1). Delayed PCI on 3–7d and >7d were strongly associated with lower risks of MACE at 30 days (3–7d: Hazard ratio (HR) 0.43 [95% Confidence interval (CI) 0.18–0.99], P=0.046; >7d: HR 0.40 [95% CI 0.19–0.87], P=0.020) and 12 months (3–7d: HR 0.49 [95% CI 0.25–0.95], P=0.036; >7d: HR 0.42 [95% CI 0.22–0.77], P=0.006) compared with that on <3d. Delayed PCI on >7d also showed improvement in 12-month mortality (HR 0.45 [95% CI 0.22–0.91], P=0.026) over that on <3d, whereas procedure on 3–7d did not (HR 0.52 [95% CI 0.24–1.11], P=0.091). MI location and cardiac function had significant interactions with procedural timing for 12-month MACE (P-interaction=0.141 and 0.137). Procedural timing had more significant effects on MACE in patients with anterior MI or cardiac insufficiency. Conclusion Delayed PCI over a week after symptom onset had significant improvement in short- and long-term safety in stable STEMI patients especially with anterior MI or cardiac insufficiency. Decision-making on optimal timing should identify the high-risk individuals and balance between ischemic benefits and safety. Figure 1 Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Twelfth Five-year Science and Technology Support Projects by Ministry of Science and Technology of China.