title: Late percutaneous coronary intervention prevents left ventricular remodeling and improves clinical outcomes in patients with ST-elevation myocardial infarction.
abstract: BACKGROUND
  The optimal strategy for treating late presenters of ST-elevation myocardial infarction (STEMI) remains uncertain.
  
  
  OBJECTIVE
  percutaneous coronary intervention (PCI) has a favorable effect on left ventricular (LV) remodeling and clinical outcomes in late presenters of STEMI.
  
  
  METHODS
  Patients with STEMI who were hospitalized between 2009 and 2011 at 7 PCI-capable hospitals in China were selected. Cardiac characteristics were reassessed by echocardiography between August 2013 and January 2014. The clinical endpoints were evaluated during a median follow-up period of 36 months.
  
  
  RESULTS
  1090 patients who either underwent late PCI (n = 786) or received standard medical therapy alone (n = 304) was analyzed. Left ventricular remodeling was more pronounced in the conservative-treatment group. Logistic regression revealed that late PCI was independently and negatively correlated with LV remodeling (odds ratio: 0.356, 95% confidence interval [CI]: 0.251-0.505, P < 0.001). Kaplan-Meier analysis showed the lower risks of major adverse cardiovascular events (MACE), all-cause death, and rehospitalization for heart failure in the late-PCI group. Multivariate Cox regression revealed that late PCI was significantly associated with lower risks for MACE, all-cause death, and rehospitalization for heart failure both in all patients (hazard ratio [HR]: 0.507, 95% CI: 0.412-0.625, P < 0.001; HR: 0.419, 95% CI: 0.314-0.559, P < 0.001; and HR: 0.583, 95% CI: 0.379-0.896, P = 0.014, respectively) and in the matched patients (HR: 0.466, 95% CI: 0.358-0.607, P < 0.001; HR: 0.398, 95% CI: 0.277-0.571, P < 0.001; and HR: 0.498, 95% CI: 0.283-0.878, P = 0.016, respectively) by propensity-score analysis.
  
  
  CONCLUSIONS
  Late-PCI strategy prevents LV remodeling and improves clinical outcomes in STEMI patients compared with conservative strategies.
authors: Department of Cardiovascular Medicine, First Affiliated Hospital of Medical College, Xi'an Jiaotong University, and Institute of Cardiovascular Channelopathy, Key Laboratory of Environment and Genes Related to Diseases of Ministry of Education, Key Laboratory of Molecular Cardiology of Shaanxi Province, Xi'an, Shaanxi, China.
authors: Yan
authors: Y
authors: Fan
authors: Xiaojun
authors: X
authors: Bai
authors: Yuewu
authors: Y
authors: Chen
authors: Guidong
authors: G
authors: Shen
authors: Qun
authors: Q
authors: Lu
authors: Zhaofei
authors: Z
authors: Wan
authors: Dong
authors: D
authors: Zhou
authors: Yuan
authors: Y
authors: Shen
authors: Aiqun
authors: A
authors: Ma
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D002681:China; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D057216:Propensity Score; D016016:Proportional Hazards Models; D012307:Risk Factors; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D016277:Ventricular Function, Left; D020257:Ventricular Remodeling
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