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Comparison of immediate outcomes in patients with ST-segment elevation myocardial infarction depending on myocardial revascularization timing

Authors: Efendieva A.S., Berdibekov B.Sh., Bulaeva N.I., Petrosyan K.V., Kudryashova E.N., Dzhidzalova D.Kh., Khoroshikh L.V., Golukhova E.Z.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery, Moscow, Russian Federation

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Type:  Original articles


DOI: https://doi.org/10.24022/1997-3187-2025-19-3-305-315

For citation: Efendieva A.S., Berdibekov B.Sh., Bulaeva N.I., Petrosyan K.V., Kudryashova E.N., Dzhidzalova D.Kh., Khoroshikh L.V., Golukhova E.Z. Comparison of immediate outcomes in patients with ST-segment elevation myocardial infarction depending on myocardial revascularization timing. Creative Cardiology. 2025; 19 (3): 305–315 (in Russ.). DOI: 10.24022/1997-3187-2025-19-3-305-315

Received / Accepted:  28.03.2025 / 09.06.2025

Keywords: acute myocardial infarction coronary artery disease percutaneous coronary intervention



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Abstract

Objective. To evaluate the impact of an invasive treatment strategy for the infarct-related artery (IRA), depending on the timing of the intervention (<12 hours vs. 12–48 hours from symptom onset), on in-hospital outcomes in patients with ST- segment elevation myocardial infarction (STEMI).

Material and methods. A single-center observational retrospective study included 209 STEMI patients who underwent stenting of the IRA. All patients were divided into two groups based on the timing of percutaneous coronary intervention of the IRA: the late revascularization group (12–48 hours from symptom onset), which included 135 patients, and the timely revascularization group (< 12 hours), which included 74 patients. The endpoints were all-cause mortality, cardiac mortality, and non-fatal recurrent myocardial infarction.

Results. No statistically significant differences were found between the groups based on revascularization timing (12–48 hours vs. < 12 hours) in terms of recurrent myocardial infarction (4 [3.0%] vs. 0 [0.0%], respectively; p = 0.30) and in- hospital mortality (5 [3.7%] vs. 0 [0.0%], respectively; p = 0.16). However, a statistically significant difference was found regarding a composite endpoint combining one or more life-threatening events. The composite endpoint occurred in 11.9% of the late revascularization group and 1.4% of the timely revascularization group (p = 0.007). Additionally, acute heart failure (AHF) developed significantly more often in the late revascularization group compared to the timely revascularization group (16 [11.9%] vs. 2 [2.7%], respectively; p = 0.03).

Multivariate regression analysis identified the following independent predictors of preoperative acute heart failure: female sex (OR 6.46; 95% CI 1.44–28.93; p = 0.02), myocardial revascularization performed more than 12 hours after symptom onset (OR 10.47; 95% CI 1.42–76.92; p = 0.02), history of atrial fibrillation (OR 8.07; 95% CI 1.14–57.38; p=0.03), and left ventricular ejection fraction below 40% (OR 26.62; 95% CI 3.78–187.42; p = 0.001).

The main reasons for delayed myocardial revascularization were late patient presentation (>12 hours from symptom onset), initial admission to a hospital lacking the necessary equipment for myocardial revascularization, and refusal of hospitalization at the initial medical contact.

Conclusion. Performing myocardial revascularization at a late stage (12–48 hours) is technically feasible and, in most cases, achieves satisfactory treatment outcomes; however, this approach is associated with an increased risk of developing acute heart failure in the preoperative period and is linked to a more severe clinical course in patients.

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About Authors

  • Anastasiya S. Efendieva, Cardiologist; ORCID
  • Bektur Sh. Berdibekov, Cand. Med. Sci., Senior Researcher, Cardiologist; ORCID
  • Naida I. Bulaeva, Cand. Biol. Sci., Head of the Department of Coordination and Support of Research Activities, Cardiologist; ORCID
  • Karen V. Petrosyan, Dr. Med. Sci., Professor, Head of the Department of X-ray Surgical Diagnostic and Treatment Methods; ORCID
  • Elena N. Kudryashova, Cardiologist; ORCID
  • Diana Kh. Dzhidzalova, Cardiologist; ORCID
  • Lyudmila V. Khoroshikh, Cardiologist; ORCID
  • Elena Z. Golukhova, Dr. Med. Sci., Professor, Academician of the Russian Academy of Sciences, Director; ORCID

Chief Editor

Elena Z. Golukhova, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, Director of Bakoulev National Medical Research Center for Cardiovascular Surgery


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