The benefits of myocardial revascularization in ST-segment elevation acute coronary syndrome (ACS) after 12 to 24 hours from symptom onset remain a topic of debate, especially in stable, asymptomatic patients.

We analyzed the benefit of late revascularization by PCI in patients admitted to Moroccan cardiac intensive care units (CICUs) with STEMI after 12 h of symptom onset.

We carried out a retrospective study between 2017 and 2021 to assess the benefit of late revascularization by PCI in STEMI patients. The primary endpoint of our study is all-cause mortality at 1-year. The secondary endpoint was a composite of readmissions for acute coronary syndrome (ACS) or acute heart failure (AHF) during follow-up.

We included a total of 406 patients who met the inclusion criteria, 262 patients in the invasive strategy group and 144 patients in the conservative strategy group. A total of 74.6% were men and 25.4% were women. For the primary outcome, death from all causes after at 2-years was observed in 46 (11.3%) of all patients, with 33 (23%) patients in the conservative strategy group, and 13 (5%) patients in the invasive strategy group, with a significant difference between the two groups (p<0.001). Kaplein Meier survival analysis showed a significant difference in survival rate with a significant Lok-rank test (p<0.001) (Fig. 1). For secondary outcomes, 19 (4.7%) patients were readmitted for ACS, and 14 (3.4%) patients for AHF, but with no significant difference for either in the two groups (p=0.277, p=0.205). Cardiogenic shock in the ICU was higher in the conservative strategy group, with a percentage of 19.4% versus 7.25% in the invasive strategy group, with a significant difference (p<0.001). In multivariable analysis, 2-year all-cause mortality was independently associated with revascularization between 12 h and 48 h (HR at 0.372, 95% CI (0.182; 0.762), p=0.007), EF<35% at discharge (HR at 1.92, 95% CI (1.22; 2.54), p=0.04) and cardiogenic shock in-CICU (HR at 2.69, 95% CI (1.82; 3.78), p=0.005).

Although no evidence exists to date on the true benefit of late PCI revascularization in STEMI patients, this practice remains common, as demonstrated by the results of the majority of registries.