Impact of Timing on Outcomes in Rescue PCI for STEMI: Early vs. Late Intervention AHA Conference Repository

American Heart Association

129

Final ID: Sa4027

Impact of Timing on Outcomes in Rescue PCI for STEMI: Early vs. Late Intervention

Abstract Body (Do not enter title and authors here):
Introduction:
American guidelines recommend rescue PCI within 3 to 24 hours after failed fibrinolysis in patients with ongoing ischemia, hemodynamic instability, or other high-risk features. Given the large areas covered by relatively few centers, rescue PCI can be delayed.
Aims
This abstract aims to compare complications in patients undergoing early rescue PCI (within 6 hours post-thrombolysis) versus late rescue PCI (more than 6 hours post-thrombolysis).
Methods
A prospective registry was conducted, patients over 18 years with diagnosis of STEMI undergoing rescue PCI (reperfusion therapy when thrombolysis has failed) in a tertiary cardiology center in Mexico from august of 2023 to april of 2024 were included. We divided patients into two groups, the ones who received early rescue PCI (within 6 hours post-thrombolysis) versus late rescue PCI (more than 6 hours post-thrombolysis).
Results
109 patients who received late Rescue PCI and 56 patients who received early Rescue PCI were included. Baseline characteristics in patients undergoing Rescue PCI before and after 6 hours are presented in table 1. Patients who underwent late rescue PCI showed worsening heart failure (KK: Killip Kimball IV) 14.2% vs 9.1% (p= 0.319.). The Major adverse cardiovascular events (MACE) reported with statistical significance are angina (p value 0.048) and especially renal failure (p= 0.016). The survival rate was significantly higher when the patient entered rescue PCI after 6 hours 95.4% vs 89.2% (p = 0.023).
Conclusion:
Although no specific time frame has been set for rescue PCI, patients who underwent to rescue PCI within six hours showed worsening outcomes such as angina and renal failure, possibly due to higher KK grades, the onset of cardiogenic shock, and lower survival rates. A major limitation of our study was the small sample size, which restricted comparisons of MACE with other outcomes. This limitation is expected to improve as our database expands. Despite these findings, it is essential to base the decision to perform a rescue PCI on the patient's initial condition upon arrival at a capable PCI center.

Adib Gracia, Anna Elisa ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )
Ontiveros Mercado, Heriberto ( Hospital Juarez de Mexico , Mexico , Mexico )
Arias, Alexandra ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )
Santiago Hernández, Alberto ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )
Neri Bale, Raul Rodrigo ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )
Cuellar, Jorge ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )
Gonzalez Macedo, Eder ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )
Diaz, Braiana ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )
Latapi Ruiz Esparza, Ximena ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )
Garcia Villarejo, Mariana ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )
Araiza, Diego ( National Institute of Cardiology Ignacio Chávez , Mexico city , Mexico )

Author Disclosures:

Anna Elisa Adib Gracia: