Title : Outcome of Late Percutaneous Coronary Revascularization versus Optimum Medical Management in Acute ST-Elevation Myocardial Infarction
Abstract:
Background: Early revascularization is the cornerstone of management in ST-elevation myocardial infarction (STEMI), yet a substantial proportion of patients in resource-limited settings present beyond 24 hours, where the benefit of late percutaneous coronary intervention (PCI) remains uncertain.
Objective: To compare the clinical outcomes of late percutaneous coronary revascularization versus optimum medical management (OMT) in patients with STEMI presenting after 24 hours from symptom onset.
Methods: This retrospective observational study was conducted at the Department of Cardiology, Combined Military Hospital, Dhaka. A total of 176 patients were included, with 88 undergoing late PCI and 88 receiving OMT. The primary outcome was MACE during hospitalization and at 6 months. Secondary outcomes included LVEF, left ventricular dimensions (LVIDd and LVIDs), and functional status by Duke treadmill score. Analysis used SPSS version 25.0.
Results: The mean age was 58.6±10.8 years, with male predominance (81.3%). The incidence of MACE at 6 months was significantly lower in the late PCI group compared to the OMT group (p=0.035), including fewer heart failure hospitalizations (p=0.025). Improvement in LVEF was greater in the late PCI group compared to OMT ((51.8±5.7% vs. 47.3±6.2%, p<0.001)). Left ventricular remodeling was significantly less pronounced in the PCI group. Functional capacity was also superior in the PCI group (mean Duke score 6.2±2.1 vs. 4.1±2.4, p<0.001).
Conclusion: Late PCI in stable STEMI patients presenting after 24 hours is associated with improved clinical outcomes, better left ventricular function, and reduced MACE compared to optimum medical management alone.
Keywords: STEMI, Late PCI, OMT, MACE, Left ventricular function, Ventricular remodeling, Duke treadmill score.
