Abstract 9764: Clinical Characteristics and Temporal Trends Among Patients Presenting Late (>12 Hours After Symptom Onset) With ST-Elevation Myocardial Infarction - A Report From the NCDR®
Background: Late presentation after ST-elevation myocardial infarction (STEMI) is associated with poor outcomes. However, contemporary data regarding management and outcomes of such patients are lacking.
Methods: Using data from the ACTION Registry-GWTG, we identified 170,247 patients who presented with STEMI to 688 US sites, between 7/08 and 12/13. Patients were stratified according to time from symptom onset to presentation as timely presenters (<12 hours) and late presenters (≥12 hours). Baseline characteristics, management and in-hospital outcomes were compared between the groups. Among late presenters, temporal trends in reperfusion strategy were also examined.
Results: A total of 9389 patients (5.5%) had late presentation and 160,858 (94.5%) had timely presentation. Late presenters were more frequently elderly, female and of non-White ethnicity (Table). Late presenters were less likely to have prior MI or prior revascularization, but more likely to have diabetes. Compared with timely presenters, late presenters had worse in-hospital outcomes including mortality (6.3% vs. 5.2%; p<0.0001). Over the 6-year study period, the proportion of late presenters decreased slightly (5.8 vs. 5.4% respectively; p=0.03), while the proportion of late presenters undergoing primary PCI increased from 65% to 71% (p<0.001). Over the same time-period, among late presenters, median time from symptom onset to presentation increased slightly, door to balloon time decreased, and in-hospital mortality remained unchanged (6.0% vs. 6.0%).
Conclusions: In contemporary practice, a modest proportion of STEMI patients continue to present >12 hours after symptom onset. Despite increased use of primary PCI and reduction in door-to-balloon times, the unadjusted mortality remains high among late presenters. Continued efforts to educate the public in order to reduce the proportion of late presenters remains warranted.
Author Disclosures: P.K. Sharma: Ownership Interest; Significant; Co-Founder InnovaHeart LLC. M.T. Roe: Research Grant; Modest; Eli Lilly, Amgen, Sanofi-Aventis, Daiichi Sankyo, Familial Hypercholesterolemia Foundation.. Speakers Bureau; Modest; Astra Zeneca, Bristol Myers Squib. Consultant/Advisory Board; Modest; Eli Lilly, Janssen, Elsevier. Consultant/Advisory Board; Significant; Astra Zeneca, Merck, Amgen. F. Kureshi: None. D.N. Holmes: None. B.K. Nallamothu: None. D.J. Cohen: Speakers Bureau; Modest; Astra Zeneca, Eli Lily. Consultant/Advisory Board; Modest; Astra Zeneca, Eli Lilly, Medtronic, Abbott Vascular. Research Grant; Significant; Medtronic, Edwards Lifesciences, Abbott Vascular, Boston Scientific, Eli Lilly, Daiichi Sankyo, Astra Zeneca, Merck, Biomet, Cardiovascular Systems, Inc..
- © 2014 by American Heart Association, Inc.