Authors

• Jasna Čerkez Habek — University Hospital “Sveti Duh”, Zagreb, Croatia — ORCID: 0000-0003-3177-3797
• Jozica Šikić — University Hospital “Sveti Duh”, Zagreb, Croatia — ORCID: 0000-0003-4488-0559
• Dario Gulin — University Hospital “Sveti Duh”, Zagreb, Croatia — ORCID: 0000-0001-8502-7816

Keywords

acute ST segment elevation myocardial infarction, late prestentation, reperfusion therapy

DOI

Full Text

**Introduction:** The European (ESC) Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation (STEMI) undoubtedly state reperfusion therapy as the superior therapeutic measure if less than 12 hours have elapsed from the onset of symptoms; in case that 12-24 hours have elapsed from pain onset, patients with signs of onging ischemia in ECG and/or persisting chest pain will benefit from prompt reperfusion. There is no consensus on the procedure in asymptomatic patients presenting beyond 12 hours of pain onset; when to perform percutaneous reperfusion and in which patients; it has not yet been defined what is long-term benefit of late recanalization of occluded artery in the infarction area. (1, 2) Aim: To determine the mode of treatment and outcome in late presenting STEMI patients at Cardiovascular Department University Hospital „Sveti Duh“. **Patients and Methods**: Data on STEMI patients hospitalized at Department from January 1, 2014 to August 31, 2016 were retrospectively analyzed with special reference to the mode of treatment and patient outcome (mortality, heart failure, myocardial reinfarction and repeat percutaneous coronary intervention (PCI)). **Results:** A total of 281 STEMI patients, 204 (72%) male and 77 (28%) female, average age 64 years, were hospitalized during the study period. Chest pain present for less than 12 hours was reported by 207 (73.6%) patients; 195 (94%) of them were successfully treated by PCI, while 12 (5.7%) patients died. Acute stent thrombosis was recorded in 4 (1.9%) patients, 24 (11.5%) patients underwent PCI on major residual stenoses, and stent re-stenosis developed in 6 (2.9%) patients. In the group of 74 (26.3%) patients with late presentation, primary PCI was successfully performed in 37 (50%) patients, while it could not be applied in the rest of 37 (50%) patients due to comorbidities; 7 patients died (9%), all of them was without reperfusion therapy; 7 patients were referred for cardiac surgery revascularization following re-coronarography on their next hospitalization. **Conclusion:** Percutaneous reperfusion was performed less frequently in STEMI patients with late presentation, resulting in higher mortality rate as compared with patients presenting within 12 hours of symptom onset. Results were compared with literature data.

Literature

1. Cohen M, Boiangiu C, Abidi M. Therapy for ST-segment elevation myocardial infarction patients who present late or are ineligible for reperfusion therapy. J Am Coll Cardiol. 2010;55:1895–906. https://doi.org/10.1016/j.jacc.2009.11.087
2. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–619. https://doi.org/10.1093/eurheartj/ehs215