Clin Med (Lond). 2026 Jun 5:100602. doi: 10.1016/j.clinme.2026.100602. Online ahead of print.
ABSTRACT
BACKGROUND: The benefit of primary percutaneous coronary intervention (PPCI) performed beyond 6hours after ST-segment elevation myocardial infarction (STEMI) symptom onset remains uncertain.
METHODS: Patients presenting with STEMI from January 2009 to December 2022 were consecutively enrolled and stratified into three groups: PPCI within 6h, PPCI beyond 6h, and no PPCI. Clinical outcomes were compared using Cox multivariable analyses and propensity score matching.
RESULTS: A total of 3720 patients were included (77.4% male, mean age 62.61 ± 12.66 years). Patients were divided into PPCI within 6h group (n = 1127, 30.3%), PPCI beyond 6h group (n = 587, 15.8%), and no PPCI group (n = 2006, 53.9%). In-hospital mortality rates were 2.8%, 4.1%, and 5.2%, respectively (p = 0.006), with pairwise analysis revealing significant differences among the groups. During a median follow-up of 4.96 years, cumulative mortality was 13.1% in PPCI within 6h group, 16.0% in PPCI beyond 6h group, and 24.0% in no PPCI group (P < 0.001). PPCI within 6h was associated with lower mortality [adjusted hazard ratio (HR) 0.565 (0.429-0.744), p < 0.001] or MACCE [adjusted HR 0.765 (0.640-0.914), p = 0.003], while PPCI beyond 6h showed comparable cumulative mortality [adjusted HR 0.766 (0.575-1.020), p = 0.068] and MACCE [adjusted HR 0.884 (0.721-1.083), p = 0.234] versus no PPCI. Concordant results were observed in propensity score-matched cohorts.
CONCLUSION: While PPCI beyond 6hours of symptom onset may improve in-hospital outcomes in STEMI patients, it is necessary to perform PPCI within 6hours to achieve significant long-term benefits.
PMID:42250767 | DOI:10.1016/j.clinme.2026.100602