You are on page 1of 7

Benefit of Percutaneous Coronary Intervention in Early

Latecomers With Acute ST-Segment Elevation


Myocardial Infarction
Doo Sun Sim, MD, PhDa, Myung-Ho Jeong, MD, PhDa,*, Youngkeun Ahn, MD, PhDa,
Young Jo Kim, MD, PhDb, Shung Chull Chae, MD, PhDc, Taek Jong Hong, MD, PhDd,
In Whan Seong, MD, PhDe, Jei Keon Chae, MD, PhDf, Chong Jin Kim, MD, PhDg,
Myeong Chan Cho, MD, PhDh, Seung-Woon Rha, MD, PhDi, Jang Ho Bae, MD, PhDj,
Ki Bae Seung, MD, PhDk, and Seung Jung Park, MD, PhDl; Other Korea Acute Myocardial
Infarction Registry (KAMIR) Investigators
The clinical benefit of percutaneous coronary intervention (PCI) is controversial in stable
early latecomers with ST-segment elevation myocardial infarction (STEMI). We evaluated
the efficacy of PCI in 2,344 stable patients with STEMI presenting 12 to 72 hours after
symptom onset. Patients who had impaired hemodynamics or who had undergone fibrinolysis or immediate or urgent PCI were excluded. The patients were divided into the PCI
group (n 1,889) and medical treatment group (n 455). The 12-month clinical outcome
was compared between the 2 groups. After adjustment using propensity score stratification,
the PCI group had lower mortality (3.1% vs 10.1%; hazard ratio 0.31; 95% confidence
interval 0.20 to 0.47; p <0.001) and a lower incidence of composite death/myocardial
infarction (3.8% vs 11.2%; hazard ratio 0.36; 95% confidence interval 0.25 to 0.53; p <
0.001) at 12 months. The benefit of PCI was consistent across all subgroups, including
patients presenting without chest pain. In conclusion, in stable patients with STEMI
presenting 12 to 72 hours after symptom onset, PCI was associated with significant
improvement in the 12-month clinical outcome. 2012 Elsevier Inc. All rights reserved.
(Am J Cardiol 2012;110:12751281)
The clinical benefit of reperfusion is controversial for
stable patients with ST-segment elevation myocardial infarction (STEMI) presenting 12 to 24 hours after the onset
of symptoms and largely unrelated to myocardial salvage.1,2
However, viable myocardium can be found even after ischemia of 12 hours3,4 and the period to salvage viable
myocardium can extend to several days.5 The accepted

Chonnam National University Hospital, Gwangju, Republic of Korea;


Yeungnam University Hospital, Daegu, Republic of Korea; cKyungpuk
National University Hospital, Daegu, Republic of Korea; dBusan National
University Hospital, Busan, Republic of Korea; eChungnam National University Hospital, Daejon, Republic of Korea; fChunbuk National University
Hospital, Jeonju, Republic of Korea; gKyung Hee University Hospital at
Gangdong, Seoul, Republic of Korea; hChungbuk National University
Hospital, Cheongju, Republic of Korea; iKorea University Guro Hospital,
Seoul, Republic of Korea; jKonyang University Hospital, Daejon, Republic
of Korea; kCatholic University Seoul St. Marys Hospital, Seoul, Republic
of Korea; and lAsan Medical Center, Seoul, Republic of Korea. Manuscript
received April 23, 2012; revised manuscript received and accepted June 20,
2012.
This study was performed with the support of the Korean Circulation
Society, Seoul, Republic of Korea in commemoration of its 50th Anniversary and grant A084869 from the Korea Healthcare Technology R&D
Project, Ministry for Health, Welfare and Family Affairs, Republic of
Korea.
*Corresponding author: Tel: (82) 62-220-6243; fax: (82) 62-2287174.
E-mail address: myungho@chollian.net (M.-H. Jeong).
b

0002-9149/12/$ see front matter 2012 Elsevier Inc. All rights reserved.
http://dx.doi.org/10.1016/j.amjcard.2012.06.028

definition of early latecomers refers to patients with


STEMI presenting 12 to 72 hours after the onset of symptoms.6 Several recent studies evaluating the efficacy of
percutaneous coronary intervention (PCI) in early latecomers have shown conflicting results.712 In the present study,
we sought to assess the benefit of PCI in stable, early
latecomers with STEMI using the database of the Korea
Acute Myocardial Infarction Registry.
Methods
The Korea Acute Myocardial Infarction Registry is the
first nationwide, population-based, multicenter data collection registry in Korea designed to track the outcomes of
patients presenting with acute myocardial infarction
(MI).13,14 The diagnosis of acute MI was determined by a
typical increase and decrease in biochemical markers of
myocardial necrosis (including creatine kinase-MB and troponin I and T), with 1 of the following: ischemic symptoms, electrocardiographic changes indicative of ischemia
(ST-segment elevation or depression), and the development
of pathologic Q waves on the electrocardiogram. The study
population was derived from patients in the Korea Acute
Myocardial Infarction Registry enrolled from November
2005 to January 2008. We included patients (aged 18
years) with persistent ST-segment elevation 0.1 mV in 2
contiguous precordial leads or 2 adjacent limb leads or
new or presumably new left bundle branch block. From this
population, we excluded patients with cardiac arrest, venwww.ajconline.org

1276

The American Journal of Cardiology (www.ajconline.org)

Table 1
Baseline clinical characteristics between percutaneous coronary intervention (PCI) and medical therapy groups
Variable
Age (years)
Men
Smoker
Hypertension
Diabetes mellitus
Dyslipidemia
Chronic kidney disease
Myocardial infarction
Angina pectoris
Percutaneous coronary intervention
Coronary bypass
Heart failure
Stroke
Peripheral artery disease
Presentation data
Interval from symptom onset (hours)
Chest pain
Systolic blood pressure (mm Hg)
Diastolic blood pressure (mm Hg)
Heart rate (beats/min)
Killip class
I
II
Preinfarct angina pectoris
Q waves
Left bundle branch block
Anterior myocardial infarction
Left ventricular ejection fraction (%)
Laboratory findings
Total cholesterol (mg/dl)
Low-density lipoprotein cholesterol (mg/dl)
High-density lipoprotein cholesterol (mg/dl)
Triglycerides (mg/dl)
Creatinine (mg/dl)
Peak troponin I (ng/ml)
Glucose at admission (mg/dl)
High-sensitivity C-reactive protein at admission (mg/dl)
N-terminal pro-B-type natriuretic peptide at admission (pg/ml)

PCI
(n 1,889)

Medical Therapy
(n 455)

p Value

66 (5573)
1,314 (69.6%)
1,078 (57.1%)
1,021 (54.0%)
506 (26.8%)
193 (10.2%)
35 (1.9%)
86 (4.6%)
87 (4.6%)
75 (4.0%)
10 (0.5%)
18 (1.0%)
129 (6.8%)
17 (0.9%)

69 (5776)
269 (59.1%)
221 (48.6%)
236 (51.9%)
129 (28.4%)
42 (9.2%)
24 (5.3%)
46 (10.1%)
41 (9.0%)
34 (7.5%)
4 (0.9%)
32 (7.0%)
54 (11.9%)
12 (2.6%)

0.001
0.001
0.001
0.40
0.50
0.53
0.001
0.001
0.001
0.001
0.49
0.001
0.001
0.003

22 (1534)
1,521 (80.5%)
130 (110146)
80 (7090)
76 (6686)

23 (1635)
312 (68.6%)
130 (110150)
80 (7087)
78 (6892)

0.84
0.001
0.57
0.50
0.001
0.001

1,555 (82.3%)
334 (17.7%)
876 (46.4%)
372 (19.7%)
12 (0.6%)
830 (43.9%)
53 (4660)

338 (74.3%)
117 (25.7%)
199 (43.7%)
74 (16.3%)
8 (1.8%)
166 (36.5%)
53 (4460)

182 (157211)
114 (95141)
43 (3751)
104 (76152)
0.9 (0.81.1)
15 (539)
130 (109168)
1.2 (0.43.9)
1,020 (6831,291)

171 (143202)
108 (80128)
43 (3653)
102 (69132)
1.0 (0.81.3)
8 (217)
131 (108169)
1.2 (0.43.7)
1,020 (8571,854)

0.31
0.09
0.04
0.004
0.13
0.001
0.001
0.51
0.002
0.001
0.001
0.84
0.91
0.002

Continuous variables are presented as the median (interquartile range) and other data as n (%).

tricular arrhythmia, advanced atrioventricular block, systolic blood pressure 90 mm Hg, heart rate 100 beats/
min, or Killip class III-IV at presentation. We also excluded
patients who had undergone fibrinolysis. Of the 7,885 patients who presented within 72 hours after symptom onset,
2,640 patients presenting 12 to 72 hours were selected:
2,185 underwent PCI and 455 received conservative medical treatment. Of the 2,185 patients in the invasive cohort,
236 underwent immediate PCI (median interval from arrival
59 minutes), 60 underwent urgent PCI during conservative
treatment (median interval from arrival 68 hours), and 1,889
underwent elective PCI (median interval from arrival 23
hours). Because it was difficult to capture the fluctuation of
chest pain and/or ST-segment elevation from our registryto compensate for the potential selection bias associated with thiswe excluded patients receiving immediate
and urgent PCI, and compared the 12-month clinical out-

comes of patients who underwent elective PCI (n 1,889)


versus those who received medical therapy (n 455). The
median interval from arrival to PCI was 23 hours (range 13
to 47). The present study was conducted according to the
Declaration of Helsinki. The institutional review board of
all participating centers approved the study protocol (approval no. 05-49 of Chonnam National University Hospital). All the participating patients provided written informed
consent. The primary end point was the occurrence of death
or recurrent MI at 12 months between the PCI and medical
therapy groups. Death was defined as death from any cause.
Recurrent MI was defined as the recurrence of symptoms or
the presence of electrocardiographic changes in association
with an increase in the cardiac biomarker levels greater than
the upper limit of normal.
The baseline differences between the 2 groups were
compared using the MannWhitney U test for continuous

Coronary Artery Disease/PCI in Early Latecomers With STEMI

1277

Table 2
Characteristics of procedures, complications, and medical treatment during hospitalization between percutaneous coronary intervention (PCI) and medical
therapy groups
Variable
Procedure
Coronary angiography
Infarct-related artery
Left main
Left anterior descending
Left circumflex
Right coronary
Prepercutaneous coronary intervention Thrombolysis In Myocardial Infarction flow
0
1
2
3
Complications during hospitalization
Cardiogenic shock
Atrial fibrillation
Ventricular tachycardia/fibrillation
Advanced atrioventricular block
Cardiovascular resuscitation
Intra-aortic balloon counterpulsation
Mechanical ventilation
Temporary cardiac pacing
Acute kidney injury
Major bleeding
Acute stroke
Medical treatment during hospitalization
Unfractionated heparin
Low-molecular-weight heparin
Aspirin
Clopidogrel
Cilostazol
Blockers
Calcium channel blockers
Angiotensin-converting enzyme inhibitor/angiotensin receptor blocker
Diuretics
Long-acting nitrates
Statin

PCI
(n 1,889)

Medical Therapy
(n 455)

p Value

1,889 (100%)

132 (29.0%)

0.001
0.39

43 (2.3%)
883 (46.7%)
387 (20.5%)
576 (30.5%)

6 (4.5%)
63 (47.7%)
24 (18.2%)
39 (29.5%)

808 (42.8%)
242 (12.8%)
296 (15.7%)
543 (28.7%)

35 (26.5%)
15 (11.4%)
20 (15.2%)
62 (47.0%)

30 (1.6%)
6 (0.3%)
20 (1.1%)
21 (1.1%)
15 (0.8%)
36 (1.9%)
23 (1.2%)
33 (1.7%)
6 (0.3%)
5 (0.3%)
3 (0.2%)

14 (3.1%)
2 (0.4%)
10 (2.2%)
1 (0.2%)
12 (2.6%)
2 (0.4%)
14 (3.1%)
1 (0.2%)
5 (1.1%)
2 (0.4%)
4 (0.9%)

0.001

1,134 (60.0%)
656 (34.7%)
1,877 (99.4%)
1,862 (98.6%)
596 (31.6%)
1,491 (78.9%)
222 (11.8%)
1,600 (84.7%)
471 (24.9%)
1,315 (69.6%)
1,493 (79.0%)

0.04
0.66
0.05
0.10
0.001
0.03
0.004
0.01
0.05
0.63
0.03

258 (56.7%)
135 (29.7%)
431 (94.7%)
405 (89.0%)
27 (5.9%)
300 (65.9%)
97 (21.3%)
344 (75.6%)
187 (41.1%)
325 (71.4%)
277 (60.9%)

0.19
0.04
0.001
0.001
0.001
0.001
0.001
0.001
0.001
0.45
0.001

Data are presented as n (%).

Table 3
Unadjusted and adjusted clinical outcomes between percutaneous coronary intervention and medical therapy groups
Variable

In-hospital
Death
At 30 days
Death
Death/myocardial infarction
At 6 mo
Death
Death/myocardial infarction
At 12 mo
Death
Death/myocardial infarction

PCI
(n 1,889)

Medical Therapy
(n 455)

32 (1.7%)

Unadjusted

Adjusted*

HR (95% CI)

p Value

HR (95% CI)

24 (5.3%)

0.31 (0.180.53)

0.001

0.39 (0.220.70)

0.002

40 (2.1%)
43 (2.3%)

37 (8.1%)
39 (8.6%)

0.26 (0.170.41)
0.27 (0.170.41)

0.001
0.001

0.29 (0.180.47)
0.30 (0.190.48)

0.001
0.001

50 (2.6%)
58 (3.1%)

43 (9.5%)
47 (10.3%)

0.27 (0.180.41)
0.29 (0.200.43)

0.001
0.001

0.29 (0.190.45)
0.31 (0.210.48)

0.001
0.001

58 (3.1%)
72 (3.8%)

46 (10.1%)
51 (11.2%)

0.29 (0.200.43)
0.33 (0.230.47)

0.001
0.001

0.31 (0.200.47)
0.36 (0.250.53)

0.001
0.001

* Stratified by the propensity score.


CI confidence interval; HR hazard ratio.

p Value

1278

The American Journal of Cardiology (www.ajconline.org)

Figure 1. PCI versus medical therapy and rates of death and MI at 12 months before and after adjustment by stratification by the propensity score. *Test for
heterogeneity, p 0.885. CI confidence interval; PS propensity score.

variables and the chi-square test or Fishers exact test for


categorical variables. Unadjusted hazard ratios and their
95% confidence intervals were calculated for the outcome
variables. To adjust for the bias inherent in the decision of
choosing PCI or medical therapy, propensity scores were
used.15,16 The propensity scores were estimated for the
likelihood of receiving PCI using a multiple logistic regression model that contained all covariates listed in Tables 1
and 2, except for diastolic blood pressure, total cholesterol,
and procedures. Model discrimination was measured by the
c-statistic, and calibration was assessed using the Hosmer
Lemeshow goodness-of-fit test (c-statistic 0.82, Hosmer
Lemeshow, p 0.68). The propensity scores were divided
into quintiles to eliminate bias due to an imbalance in the
measured covariates between the 2 groups.17 The degree to
which the propensity score balanced the measured covariates was assessed by comparing the standardized differences in the mean values of each covariate. After adjustment
by stratification on the propensity score, the standardized
differences of all covariates were 0.25, suggesting that all
the measured covariates were well balanced between the 2
groups.18 The treatment effect was estimated separately
within each quintile, and a pooled average treatment
effect was obtained by combining the estimates across
the quintiles. Statistical analyses were conducted using
SPSS, version 18.0 (SPSS, Chicago, Illinois) and R,
version 2.13.1 (R Foundation for Statistical Computing,
Vienna, Austria). All statistical tests were 2-sided, with a
significance level of p 0.05.
Results
The baseline characteristics, in-hospital treatments, and
outcomes of the 2,344 early latecomers with STEMI are
listed in Tables 1 and 2. The patients undergoing PCI were
younger, more often men and smokers, and more likely to have
chest pain at presentation, anterior MI, elevated levels of
cholesterols and troponins, and to receive adequate med-

Figure 2. Death/MI-free survival at 12 months between PCI and medical


therapy groups after adjustment by stratification by the propensity
score. CI confidence interval; HR hazard ratio.

ical treatment during hospitalization. Unadjusted in-hospital mortality was lower in the PCI group (1.7% vs
5.3%, p 0.001; Table 3). The rates of death or MI at 12
months were also lower in the PCI group (3.8% vs 11.2%,
p 0.001). After adjustment, PCI was still associated with
lower in-hospital mortality (hazard ratio 0.39, 95% confidence interval 0.22 to 0.70; p 0.002). The 12-month
death/MI rates remained significantly lower in the PCI
group (hazard ratio 0.48, 95% confidence interval 0.33 to
0.70; p 0.001; Table 3 and Figures 1 and 2). In each
quintile of propensity for PCI, the 12-month death/MI rates
were lower for patients who underwent PCI than for those
who did not, with a hazard ratio of 0.30 to 0.64 (test for
heterogeneity, p 0.885), indicating that patients with the
same likelihood of undergoing PCI were more likely to
benefit if they actually underwent PCI (Figure 1). Additional analysis revealed that the favorable outcomes associ-

Coronary Artery Disease/PCI in Early Latecomers With STEMI

1279

Figure 3. Subgroup analysis of 12-month death/MI. CI confidence interval; HR hazard ratio; TIMI Thrombolysis In Myocardial Infarction.

ated with PCI applied to all subgroups, including patients


presenting without chest pain (Figure 3).
Discussion
The present study has shown that in patients with stable
STEMI presenting 12 to 72 hours after symptom onset, PCI
is associated with significantly lower rates of 12-month
death/MI than conservative medical treatment. Currently, it
is thought that for stable patients with STEMI presenting
12 to 24 hours after the symptom onset, the clinical
benefit of reperfusion is controversial and largely unrelated
to myocardial salvage.1,2 However, it has been suggested
that viable myocardium can be found even after ischemia of
12 hours,3,4 and preserved residual flow in the infarctrelated artery (IRA) is associated with reduced infarct size,
better left ventricular function, and improved clinical outcomes compared to a totally occluded IRA.4,19 21 Residual
anterograde coronary flow and collateral circulation can
ensure stunned or hibernated myocardium within the area at
risk and the interval to salvage viable myocardium can
extend to several days.5
The accepted definition of early latecomers refers to
patients with STEMI presenting 12 to 72 hours after the
onset of symptoms.6 Recent studies evaluating the efficacy
of PCI in early latecomers have shown conflicting results.7,9 12 The Beyond 12 hours Reperfusion AlternatiVe

Evaluation (BRAVE-2) trial7 included 365 patients57%


with Thrombolysis in Myocardial Infarction 0-1 flow
without persistent symptoms, who presented 12 to 48 hours
after the onset of STEMI. The main result was a significant
infarct size reduction in patients treated with PCI compared
to patients treated conservatively (8% vs 13%, p 0.001).
The Occluded Artery Trial (OAT)8 randomized 2,166 stable
late presenters (24 hours from symptom onset) undergoing coronary angiography 3 to 28 days after acute MI to PCI
(n 1,082) or conservative medical therapy (n 1,084).
Routine PCI for a totally occluded IRA failed to reduce the
incidence of major cardiovascular events during 4 years of
follow-up. The lack of clinical benefit of PCI remained
consistent in the OAT substudy of 331 patients enrolled 24
to 72 hours after the onset of acute MI.9 The discrepancy
between these 2 randomized trials might be related to the
differences in the patients enrolled.6 Of the patients in the
invasive arm of the BRAVE-2 trial,7 43% had a patent IRA
and patients with severe inducible ischemia were not excluded. In contrast, all the patients in the OAT had a totally
occluded IRA and patients with severe inducible ischemia
were excluded. This finding might suggest a role for the
patency of the IRA in the salvage of myocardium at risk in
early latecomers undergoing PCI. Busk et al10 investigated
the relationship of IRA patency to myocardial salvage and
left ventricular remodeling after primary PCI in 396 patients
with STEMI: 341 patients presenting 12 hours and 55

1280

The American Journal of Cardiology (www.ajconline.org)

presenting 12 to 72 hours from symptom onset. Latecomers


(12 to 72 hours after symptom onset) with a totally occluded
IRA had a larger infarct size, lower salvage index (percentage of noninfarcted area at risk), and a lower left ventricular
ejection fraction compared with the early presenters. Late
presenters with a patent IRA had a larger infarct size but the
salvage index and left ventricular ejection fraction did not
differ compared to the early presenters, indicating a larger
amount of ischemic myocardium can be salvaged even in
late presenters if the IRA is patent. These findings might
support the importance of IRA patency in planning the
optimal timing to perform PCI in late presenters. Although
no period has been established for reperfusion in late presenters with STEMI, the findings from these 3 trials might
indicate that PCI within 48 to 72 hours after symptom onset
is reasonable for an occluded IRA and that reperfusion of a
patent IRA could be beneficial even later.10 It should be
noted, however, that the lack of clinical benefit of PCI in
any of these trials should be interpreted in light of the study
designs selected. The BRAVE-2 trial7 and the study by
Busk et al10 were not designed to assess differences in
clinical end points. In the OAT, PCI 3 to 28 days (median
8) after acute MI seems too late for a beneficial clinical
effect, given that all enrollees had a totally occluded IRA
without severe inducible ischemia. In addition, the OAT
substudy of early latecomers (n 331) was underpowered
to detect a benefit for PCI strategy. In contrast, in the recent
meta-analysis of late PCI for acute MI (12 hours after
symptom onset, median symptom duration 12 days, 74%
totally occluded IRA), PCI improved cardiac function and
survival.11 The benefits of PCI in terms of mortality reduction were greater when patients with a patent IRA were also
included. Similarly, in the present study (12 to 72 hours
after symptom onset, median symptom duration 22 hours;
47% with a totally occluded IRA), late PCI improved 12month clinical outcome, and the benefit was consistent
regardless of IRA patency. Taken together, these findings
support the value of timely PCI in stable early latecomers
with STEMI, particularly those with a totally occluded IRA,
although additional studies are warranted to evaluate the
efficacy and optimal timing of PCI in this patient population.
The present study had limitations. Although these results
came from a large cohort and adjustment was performed
using propensity score analysis for a large number of confounding variables, a registry study cannot replace a randomized controlled trial, and unmeasurable factors could
still exist. In addition, some important measures of patient
outcome were not collected or available for the present
analysis. These included the status of collateral circulation
and myocardial viability, amount and fluctuation of STsegment elevation and chest pain, and the use of newer
therapeutic modalities such as thrombus aspiration devices.
Acknowledgment: Korea Acute Myocardial Infarction
(KAMIR) Investigators: Myung Ho Jeong, MD, Young
Keun Ahn, MD, Shung Chull Chae, MD, Jong Hyun Kim,
MD, Seung Ho Hur, MD, Young Jo Kim, MD, In Whan
Seong, MD, Dong Hoon Choi, MD, Jei Keon Chae, MD,
Taek Jong Hong, MD, Jae Young Rhew, MD, Doo Il Kim,

MD, In Ho Chae, MD, Jung Han Yoon, MD, Bon Kwon


Koo, MD, Byung OK Kim, MD, Myoung Yong Lee, MD,
KeeSik Kim, MD, Jin Yong Hwang, MD, Myeong Chan
Cho, MD, Seok Kyu Oh, MD, Nae Hee Lee, MD, Kyoung
Tae Jeong, MD, Seung Jea Tahk, MD, Jang Ho Bae, MD,
Seung-Woon Rha, MD, Keum Soo Park, MD, Chong Jin
Kim, MD, Kyoo Rok Han, MD, Tae Hoon Ahn, MD, Moo
Hyun Kim, MD, Ki Bae Seung, MD, Wook Sung Chung,
MD, Ju Young Yang, MD, Chong Yun Rhim, MD, Hyeon
Cheol Gwon, MD, Seong Wook Park, MD, Young Youp
Koh, MD, Seung Jae Joo, MD, Soo Joong Kim, MD, Dong
Kyu Jin, MD, Jin Man Cho, MD, Yang Soo Jang, MD,
Jeong Gwan Cho, MD, and Seung Jung Park, MD.
1. Kushner FG, Hand M, Smith SC Jr, King SB III, Anderson JL,
Antman EM, Bailey SR, Bates ER, Blankenship JC, Casey DE Jr,
Green LA, Hochman JS, Jacobs AK, Krumholz HM, Morrison DA,
Ornato JP, Pearle DL, Peterson ED, Sloan MA, Whitlow PL, Williams
DO. 2009 Focused updates: ACC/AHA guidelines for the management
of patients with ST-elevation myocardial infarction (updating the 2004
guideline and 2007 focused update) and ACC/AHA/SCAI guidelines
on percutaneous coronary intervention (updating the 2005 guideline
and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice
Guidelines. J Am Coll Cardiol 2009;54:22052241.
2. Van de Werf F, Bax J, Betriu A, Blomstrom-Lundqvist C, Crea F, Falk
V, Filippatos G, Fox K, Huber K, Kastrati A, Rosengren A, Steg PG,
Tubaro M, Verheugt F, Weidinger F, Weis M; ESC Committee for
Practice Guidelines (CPG). Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation: the
Task Force on the Management of ST-Segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. Eur Heart J
2008;29:2909 2945.
3. Milavetz JJ, Giebel DW, Christian TF, Schwartz RS, Holmes DR Jr,
Gibbons RJ. Time to therapy and salvage in myocardial infarction.
J Am Coll Cardiol 1998;31:1246 1251.
4. Sabia PJ, Powers ER, Ragosta M, Sarembock IJ, Burwell LR, Kaul S.
An association between collateral blood flow and myocardial viability
in patients with recent myocardial infarction. N Engl J Med 1992;327:
18251831.
5. Sawyer DB, Loscalzo J. Myocardial hibernation: restorative or preterminal sleep? Circulation 2002;105:15171519.
6. Fontanelli A, Bonanno C. Primary percutaneous coronary intervention
in early latecomers with ST-segment elevation acute myocardial
infarction: the role of the infarct-related artery status. J Cardiovasc
Med (Hagerstown) 2011;12:1318.
7. Schmig A, Mehilli J, Antoniucci D, Ndrepepa G, Markwardt C, Di
Pede F, Nekolla SG, Schlotterbeck K, Schhlen H, Pache J, Seyfarth
M, Martinoff S, Benzer W, Schmitt C, Dirschinger J, Schwaiger M,
Kastrati A; Beyond 12 hours Reperfusion AlternatiVe Evaluation
(BRAVE-2) Trial Investigators. Mechanical reperfusion in patients
with acute myocardial infarction presenting more than 12 hours from
symptom onset: a randomized controlled trial. JAMA 2005;293:2865
2872.
8. Hochman JS, Lamas GA, Buller CE, Dzavik V, Reynolds HR, Abramsky SJ, Forman S, Ruzyllo W, Maggioni AP, White H, Sadowski Z,
Carvalho AC, Rankin JM, Renkin JP, Steg PG, Mascette AM, Sopko
G, Pfisterer ME, Leor J, Fridrich V, Mark DB, Knatterud GL; Occluded Artery Trial Investigators. Coronary intervention for persistent
occlusion after myocardial infarction. N Engl J Med 2006;355:2395
2407.
9. Menon V, Pearte CA, Buller CE, Steg PG, Forman SA, White HD,
Marino PN, Katritsis DG, Caramori P, Lasevitch R, Loboz-Grudzien
K, Zurakowski A, Lamas GA, Hochman JS. 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;30:183191.
10. Busk M, Kaltoft A, Nielsen SS, Bttcher M, Rehling M, Thuesen L,
Btker HE, Lassen JF, Christiansen EH, Krusell LR, Andersen HR,
Nielsen TT, Kristensen SD. Infarct size and myocardial salvage after

Coronary Artery Disease/PCI in Early Latecomers With STEMI

11.

12.

13.

14.

15.

primary angioplasty in patients presenting with symptoms for 12 h


vs. 1272 h. Eur Heart J 2009;30:13221330.
Abbate A, Biondi-Zoccai GG, Appleton DL, Erne P, Schoenenberger
AW, Lipinski MJ, Agostoni P, Sheiban I, Vetrovec GW. Survival and
cardiac remodeling benefits in patients undergoing late percutaneous
coronary intervention of the infarct-related artery: evidence from a
meta-analysis of randomized controlled trials. J Am Coll Cardiol
2008;51:956 964.
Elad Y, French WJ, Shavelle DM, Parsons LS, Sada MJ, Every NR.
Primary angioplasty and selection bias inpatients presenting late (12 h)
after onset of chest pain and ST elevation myocardial infarction. J Am Coll
Cardiol 2002;39:826 833.
Sim DS, Kim JH, Jeong MH. Differences in clinical outcomes between
patients with ST-elevation versus nonST-elevation acute myocardial
infarction in Korea. Korean Circ J 2009;39:297303.
Sim DS, Jeong MH, Kang JC. Current management of acute myocardial infarction: experience from the Korea Acute Myocardial Infarction Registry. J Cardiol 2010;56:17.
DAgostino RB Jr. Propensity score methods for bias reduction in the
comparison of a treatment to a non-randomized control group. Stat
Med 1998;17:22652281.

1281

16. Joffe MM, Rosenbaum PR. Invited commentary: propensity scores.


Am J Epidemiol 1999;150:327333.
17. Rosenbaum PR, Rubin DB. Reducing bias in observational studies
using subclassification on the propensity score. J Am Stat Assoc 1984;
79:516 524.
18. Rubin DB. Using propensity scores to help design observational studies: application to the tobacco litigation. Health Serv Outcomes Res
Methodol 2001;2:169 188.
19. Stone GW, Cox D, Garcia E, Brodie BR, Morice MC, Griffin J, Mattos
L, Lansky AJ, ONeill WW, Grines CL. Normal flow (TIMI-3) before
mechanical reperfusion therapy is an independent determinant of survival in acute myocardial infarction: analysis from the primary angioplasty in myocardial infarction trials. Circulation 2001;104:636 641.
20. Sabia PJ, Powers ER, Jayaweera AR, Ragosta M, Kaul S. Functional
significance of collateral blood flow in patients with recent acute
myocardial infarction: a study using myocardial contrast echocardiography. Circulation 1992;85:2080 2089.
21. Cribier A, Korsatz L, Koning R, Rath P, Gamra H, Stix G, Merchant
S, Chan C, Letac B. Improved myocardial ischemic response and
enhanced collateral circulation with long repetitive coronary occlusion
during angioplasty: a prospective study. J Am Coll Cardiol 1992;20:
578 586.

You might also like