Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction

Table 1 Comparison of baseline characteristics of the two study groups (mean ± SD)

Characteristic	Routine (n = 183)	Delayed (n = 154)	P value
Age, years	55.1 ± 10.1	54.2 ± 10.5	0.426
Age group, n (%)
20–29 yr	0	2 (1.3)	0.197
30–39 yr	13 (7.1)	10 (6.5)
40–49 yr	38 (20.8)	34 (22.1)
50–59 yr	47 (25.7)	52 (33.8)
60–69 yr	71 (38.8)	43 (27.9)
70–79 yr	14 (7.7)	13 (8.4)
Gender, n (%)
Male	160 (87.4)	138 (89.6)	0.533
Female	23 (12.6)	16 (10.4)
Risk factors, n (%)
Diabetes	37 (20.2)	34 (22.1)	0.677
Hypertension	49 (26.8)	43 (27.9)	0.814
Smoking	100 (54.6)	86 (55.8)	0.825
Killip class, n (%)
Class 1	165 (90.2)	129 (83.8)	0.176
Class 2	11 (6.0)	10 (6.5)
Class 3	5 (2.7)	10 (6.5)
Class 4	2 (1.1)	5 (3.2)
Left ventricular ejection fraction (%)	46.9 ± 4.7	45.8 ± 4.5	0.034
Type of myocardial infarction, n (%)
AWMI	98 (53.6)	88 (57.1)	0.509
Non-AWMI	85 (46.4)	66 (42.9)
Type of coronary artery disease, n (%)
SVD	105 (57.4)	89 (57.8)	0.939
MVD	78 (42.6)	65 (42.2)
Symptoms to needle time, h	5.2 ± 3.4	5.8 ± 4.5	0.125
Thrombolysis to PCI time, h	16.9 ± 5.3	44.1 ± 14.7	0.001

AWMI: Anterior wall ST segment elevation myocardial infarction; Non-AWMI: Non-anterior wall ST segment elevation myocardial infarction; SVD: Single vessel disease; MVD: Multi-vessel disease; PCI: Percutaneous coronary intervention.

Table 2 Outcomes based on primary and secondary endpoints in the two study groups

Clinical outcome	Routine (n = 183)	Delayed (n = 154)	P value
Primary endpoints, n (%)
MACCE	16 (8.7)	20 (12.9)	0.152
Secondary endpoints, n (%)
Death	5 (2.7)	3 (1.9)	0.732
Myocardial infarction	2 (1.1)	7 (4.5)	0.085
Target vessel revascularization	3 (1.6)	3 (1.9)	0.999
Congestive heart failure	6 (3.3)	7 (4.5)	0.547
Stroke	0	0	0.999
Angina	4 (2.2)	1 (0.6)	0.381
Dyspnea	6 (3.3)	5 (3.2)	0.999
Major Bleeding1	1 (0.5)	3 (1.9)	0.335

¹As defined by Bleeding Academic Research Consortium (BARC) classification.

MACCE: Major adverse cardiac and cerebrovascular events.

Table 3 Outcomes based on primary and secondary endpoints among study groups

	Routine	Delayed		P value
	Group A (≤ 24.0 h), n = 183	Group B (24.0 ≤ 48.0 h), n = 96	Group C (48.0–72.0 h), n = 58	Group A vs Group B	Group A vs Group C	Group B vs Group C
Primary outcomes, n (%)
MACCE	16 (8.7)	13 (13.5)	7 (12.06)	0.212	0.263	0.965
Secondary outcomes, n (%)
Death	5 (2.7)	2 (2.1)	1 (1.7)	0.999	0.999	0.999
Myocardial infarction	2 (1.1)	3 (3.1)	4 (6.9)	0.343	0.093	0.427
Target vessel revascularization	3 (1.6)	2 (2.1)	1 (1.7)	0.999	0.999	0.999
Congestive heart failure	6 (3.3)	6 (6.3)	1 (1.7)	0.245	0.999	0.256
Stroke	0	0	0	-	-	-
Major bleeding1	1 (0.5)	1 (1.0)	2 (3.4)	0.999	0.145	0.557

¹As defined by Bleeding Academic Research Consortium (BARC) classification.

MACCE: Major adverse cardiac and cerebrovascular events.

Table 4 Univariate analysis for prediction of primary endpoints as a measure of outcome

Variable	Events (16/183)	Routine (3-24 h)	Events (21/154)	Delayed (> 24 h)
		OR (95%CI)		OR (95%CI)
Age (> 65 yr)	1/16	0.68 (0.08-5.48)	3/18	1.31 (0.34-4.98)
Age (55-65 yr)	9/81	1.70 (0.62-4.77)	8/47	1.48 (0.57-3.86)
Age (45-55 yr)	1/41	0.21 (0.03-1.65)	5/56	0.50 (0.17-1.46)
Age (35-45 yr)	4/38	1.30 (0.40-4.30)	4/26	1.19 (0.36-3.87)
Age (< 35 yr)	1/7	1.79 (0.20-15.86)	1/7	1.06 (0.12-9.26)
Male	15/160	2.28 (0.29-18.10)	17/138	0.42 (0.12-1.46)
KILLIP Class-1	13/165	0.43 (0.11-1.67)	17/132	0.67 (0.20-2.20)
KILLIP Class-2	3/11	4.59 (1.08-19.40)	1/9	0.78 (0.09-6.59)
AWMI	9/99	1.10 (0.39-3.09)	10/88	0.64(0.25-1.61)
Type 2 DM	3/37	0.9 (0.24-3.35)	2/34	0.33(0.07-1.50)
Smoking	10/100	1.43 (0.50-4.10)	14/86	1.69 (0.64-4.47)
HTN	4/49	0.90 (0.28-2.95)	4/43	0.57 (0.18-1.79)
LVEF (35-45)	3/70	0.34 (0.09-1.25)	7/73	0.51 (0.19-1.34)
LVEF (> 45)	12/112	2.01 (0.62-6.50)	14/78	2.16 (0.82-5.68)
MVD	7/78	1.05 (0.37-2.96)	11/65	1.61 (0.64-4.05)
SVD	9/98	1.13 (0.40-3.17)	10/87	0.66 (0.26-1.66)
CrCl (30-60)	1/29	0.33 (0.04-2.61)	5/30	1.35 (0.45-4.03)
CrCl (60-90)	11/113	1.40 (0.47-4.22)	11/78	1.08 (0.43-2.72)
CrCl (> 90)	4/40	1.21 (0.37-3.99)	5/42	0.81 (0.28-2.37)

AWMI: Anterior wall ST-elevation myocardial infarction; DM: Diabetes mellitus; HTN: Hypertension; LVEF: Left ventricular ejection fraction; MVD: Multi-vessel disease; SVD: Single vessel disease; CrCL: Creatinine clearance.