New Research Shows PCI Benefits STEMI Patients Even After 12 Hours

March 16, 2015 — New research from the Minneapolis Heart Institute Foundation (MHIF) finds that percutaneous coronary intervention for heart attacks can still be beneficial for patients who get to their more than 12 hours after their chest pain has started. Timothy Henry, M.D., lead MHIF researcher and director of cardiology at Cedars-Sinai Medical Center in Los Angeles, presented the study results at the 2015 American College of Cardiology (ACC) conference in San Diego.

Almost 250,000 Americans experience ST-elevated myocardial infarction (STEMI), the deadliest form of heart attack, each year. Many of these patients are treated with percutaneous coronary intervention (PCI, or coronary artery stenting) within 90 minutes of getting to a medical center — a guideline recommended by the American Heart Association. But treatment guidelines have been less clear for patients who get to a medical center late — more than 12 hours after their chest pain has started. “Despite previous studies showing PCI improves survival for these late presenters,” said Henry, “management of these patients continues to be controversial.”

To further study the impact of PCI on STEMI patients who receive later treatment, Henry and a team of MHIF researchers examined prospective data from 3,157 patients in the Level 1 regional STEMI program at the Minneapolis Heart Institute at Abbott Northwestern Hospital from March 2003 to March 2014. They placed the patients into three groups: those that arrived at a medical center within 6 hours of chest pain starting (“early presenters”), those arriving within 6–12 hours, and those arriving 12–24 hours after the start of pain (“late presenters”).

The death rate (in-hospital, at 30 days, and at 1 year) and length of hospital stay for late presenters (6.7 percent of patients) was similar to that of early presenters. “Our research supports the use of primary PCI in late presenters,” stated Henry. “Although the door to balloon time was longer for late presenters, the clinical benefits of PCI were similar to those who received earlier treatment.”

For more information: www.mplsheart.org