Cardiovascular Journal of Africa: Vol 30 No 3 (May/June 2019)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 3, May/June 2019 166 AFRICA
We failed to find significant differences in terms of in-hospital
mortality rate and MACE between the two groups in this study.
Two reasons may explain this. First, all of the enrolled patients
were haemodynamically and electrically stable and had patent
IRAs, which means they had a relatively low risk for mortality
and adverse events, according to the GRACE scoring system.33
Second, only 159 patients were enrolled in the study, and the
small sample may have reduced the power to draw a significant
conclusion regarding mortality rate.
There were several potential limitations of this study. First,
it is a single-centre, retrospective study with a small sample size.
Second, most recent chest pain within 12 hours before admission
was more likely in the emergency PCI group compared with
the delayed PCI group (Table 2), which may have led to a bias
towards an emergency decision by the operator. Third, we did
not assess the TIMI thrombus grade of the IRA during the initial
angiography since TIMI thrombus grade may have contributed
to different angiography results. Finally, the blush grade was
not evaluated as a more valuable indicator for normalised
microvascular flow since this study was designed retrospectively.
Conclusion
In STEMI patients who presented late (12–72 hours) after
symptom onset and with an IRA TIMI flow of grade 2 to 3,
delayed PCI showed a higher rate of procedural success due to
a lower rate of slow flow or no re-flow, without an increase in
hospital or long-term MACE or mortality rates.
We thank Dr Qian-jin Feng for editing and revision of the manuscript. This
study was supported by the Zhongshan Major Science and Technology
Development Project (Zhong Ke Fa No. 2016B1002).
References
1. Hong MK. Recent advances in the treatment of ST-segment elevation
myocardial infarction. Scientifica (Cairo) 2012; 2012: 683683.
2. Eagle KA, Goodman SG, Avezum A, Budaj A, Sullivan CM, López-
Sendón J,et al . Practice variation and missed opportunities for reperfusion
in ST-segment-elevation myocardial infarction: findings from the global
registry of acute coronary events (GRACE). Lancet 2002; 359: 373–377.
3. Cohen M, Gensini GF, Maritz F, Gurfinkel EP, Huber K, Timerman
A, et al. Prospective evaluation of clinical outcomes after acute
ST-elevation myocardial infarction in patients who are ineligible for
reperfusion therapy: preliminary results from the TETAMI registry and
randomized trial. Circulation 2003; 108: III14–III21.
4. DiPede F, Olivari Z, Schievano E, Spolaore P, Cacciavillani L, La
Vecchia L, et al. Impact of reperfusion strategies on in-hospital outcome
in ST-elevation myocardial infarction in a context of interhospital
network: data from the prospective VENERE registry (VENE to acute
myocardial infarction REgistry). Ital Heart J Suppl 2005; 6: 804–811.
5. Fontanelli A, Bonanno C. Primary percutaneous coronary interven-
tion in ‘early’ latecomers with ST-segment elevation acute myocardial
infarction: the role of the infarct-related artery status. J Cardiovasc Med
(Hagerstown) 2011; 12: 13–18.
6. Li J, Li X, Wang Q, Yu Y, Yan XF, Jiang LX. ST-segment elevation
myocardial infarction in China from 2001 to 2011 (the China PEACE-
retrospective acute myocardial infarction study): a retrospective analysis
of hospital data. Lancet 2015; 385: 441–451.
7. De Luca G, Suryapranata H, Zijlstra F, van’t Hof A, Hoorntje J,
Gosselink A, et al. Symptom onset-to-balloon time and mortality in
patients with acute myocardial infarction treated by primary angio-
plasty. J Am Coll Cardiol 2003; 42: 991–997.
8. Reimer KA, Lowe JE, Rasmussen MM, Jennings RB. The wavefront
phenomenon of ischemic cell death. 1. Myocardial infarct size vs dura-
tion of coronary occlusion in dogs. Circulation 1977; 56: 786–794.
9. Hasche ET, Fernandes C, Freedman SB, Jeremy RW. Relation between
ischemia time, infarct size, and left ventricular function in humans.
Circulation 1995; 92: 710–719.
10. Shacham Y, Steinvil A, Leshem-Rubinow E, BenAssa E, Keren G, Roth
A, et al. Association between time to reperfusion and echocardiography
assessed left ventricular filling pressure in patients with first ST-segment
elevation myocardial infarction undergoing primary coronary interven-
tion. Cardiol J 2014; 21: 357–363.
11. De Luca G, Ernst N, Zijlstra F, Van’t Hof A, Hoorntje J, Dambrink
J, et al. Preprocedural TIMI flow and mortality in patients with acute
myocardial infarction treated by primary angioplasty. J Am Coll Cardiol
2004; 43: 1363–1367.
12. Ndrepepa G, Kastrati A, Schwaiger M, Mehilli J, Markwardt C, Dibra
A, et al. Relationship between residual blood flow in the infarct-related
artery and scintigraphic infarct size, myocardial salvage, and functional
recovery in patients with acute myocardial infarction. J Nucl Med 2005;
46: 1782–1788.
13. 1Schomig A, Mehilli J, Antoniucci D, Ndrepepa G , Markwardt C,
Di Pede F, e t al. A beyond 12h reperfusion alternative evaluation
(BRAVE-2) trial investigators. Mechanical reperfusion in patients with
acute myocardial infarction presenting more than 12 hours from symp-
tom onset: a randomized controlled trial. J Am Med Assoc 2005; 293:
2865–2872.
14. Busk M, Kaltoft A, Nielsen SS, Bøttcher M, Rehling M, Thuesen L,
et al. Infarct size and myocardial salvage after primary angioplasty in
patients presenting with symptoms for < 12 h vs 12–72 h. Eur Heart J
2009; 30: 1322–1330.
15. TIMI Study Group Definitions used in TIMI trials (2008). http://www.
Accessed 22 January 2008.
16. Meneveau N, Seronde MF, Descotes-Genon V, Dutheil J, Chopard
R, Ecarnot F, et al. Immediate versus delayed angioplasty in infarct-
related arteries with TIMI III flow and ST-segment recovery: a matched
comparison in acute myocardial infarction patients. Clin Res Cardiol
2009; 98: 257–264.
17. Bates ER, Hochman JS. Challenging coronary artery revascularization
paradigms. Am Heart J 2007; 154: 1005–1007.
18. Schomig A, Ndrepepa G, Kastrati A. Late myocardial salvage: time
to recognize its reality in the reperfusion therapy of acute myocardial
infarction. Eur Heart J 2006; 27: 1900–1907.
19. Sim DS, Jeong MH, Ahn Y, Kim YJ , Chae SC, Hong TJ, et al. Korea
acute myocardial infarction registry (KAMIR) investigators benefit
of percutaneous coronary intervention in early latecomers with acute
ST-segment elevation myocardial infarction. Am J Cardiol 2012; 110:
1275–1281.
20. Menon V, Pearte CA, Buller CE, Steg, PG, Forman, SA, White, HD,
et al. Lack of benefit from percutaneous intervention of persistently
occluded infarct arteries after the acute phase of myocardial infarction
is time independent: insights from occluded artery trial. Eur Heart J
2009; 30: 183–191.
21. Ndrepepa G, Kastrati A, Mehilli J, Antoniucci D, Schömig A.
Mechanical reperfusion and long-term mortality in patients with acute
myocardial infarction presenting 12 to 48 hours from onset of symp-
toms. J Am Med Assoc 2009; 301(5): 487–488.
22. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, et al. 2014