Delayed PCI may lower mortality in STEMI patients

MedWire News: Primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction offers long-term survival advantages over conservative treatment even when patients present more than 12 hours after symptom onset, the BRAVE-2 study suggests.

The BRAVE-2 (Beyond 12 hours Reperfusion Alternative Evaluation) Trial compared an invasive PCI strategy with conservative treatment in 365 patients with ST-segment elevation myocardial infarction (STEMI). All patients presented 12–48 hours after symptom onset, making them ineligible for PCI under current guidelines.

The study’s primary finding, as reported previously, was that the invasive strategy was associated with a significant reduction in infarct size 5–10 days after randomization.

The present study was a prespecified analysis of outcomes at 4 years and is published in the Journal of the American Medical Association.

The authors report that PCI was associated with a significant reduction in mortality at 4 years as compared with conservative treatment (11.1% vs 18.9%, adjusted hazard ratio=0.55, p=0.04).

The mortality curves continued to diverge over the entire follow-up period, say the authors, indicating that the clinical benefits of PCI need time to become evident.

PCI was also associated with a significantly lower rate of revascularization in the infarct-related artery (25.8% vs 69.1%, p<0.001), whereas rates of MI and stroke were similar in the invasive and conservative treatment groups.

“These findings, in addition to those demonstrating reduction of infarct size, may support the use of invasive PCI treatment in this subset of patients,” conclude Gjin Ndrepepa (Technische Universität, Munich, Germany) and co-authors.

“Larger trials are required to confirm this effect and clarify its magnitude.”