NEW YORK (Reuters Health) – In patients with ST-segment elevation myocardial infarction (STEMI), substantial myocardial salvage and reduced infarct size can be achieved even when primary angioplasty is performed 12 to 72 hours after symptom onset, results of a Danish study indicate.

Current guidelines from the European and American societies of cardiology recommend primary angioplasty for STEMI only if symptoms have been present for less than 12 hours, Dr. Martin Busk of Aarhus University Hospital, Skejby and colleagues explain in the June issue of the European Heart Journal. “However, 8.5-40% of STEMI patients are late presenters with symptoms for more than 12 h on admission.”

The clinicians evaluated final infarct size and myocardial salvage in 341 early presenters (symptom onset 50% of area at risk) was observed in 41% of late presenters despite total infarct-artery occlusion.

“Based on our study,” Dr. Busk noted, “the 12-hour cut-off point for offering primary angioplasty appears to be totally arbitrary.”

“It is unpredictable from the symptom duration as reported by the patient,” Dr. Busk said, “whether myocardial salvage can be achieved with primary angioplasty, even when the symptom duration is above 12 hours.”

Reference:
Euro Heart J 2009;30:1322-1330.