Optimizing revascularization timing in late-presenting STEMI patients: insights from post systolic index analysis

Recent issue surrounding the need of urgent PCI for stable, late-presenting patients with ST-elevation myocardial infarction is debatable. Research indicates limited mortality benefits with reduced total ischemic time. Exploring post-systolic index (PSI) through strain echocardiography reveals its potential in assessing left ventricular recovery. We compare PSI values in late presenter STEMI patients undergoing PCI. From June to September 2023, a prospective study focused on stable late presenter STEMI patients undergoing PCI. Total ischemic time was classified as ≤ 24 hours (early intervention) and > 24 hours (late intervention). Echocardiography performed thrice: before PCI, 24 hours after PCI, and 30 days after PCI, followed by comparative analysis of PSI values. A total of 43 patients with mean age of 58 ± 7.9 years, predominantly male (74.4%). There were no significant difference in PSI values 24 hours after PCI between groups [22.5 % vs 22.0 %, p = 0.644]. At the 30-day follow-up, the result showed no difference between the two groups [13.0 % vs 13.3 %, p = 0.356]. PSI values before and after PCI showed a significant decrease (31,0 % and 23,2 % and 33,2 % vs 24,9 %, p < 0,001), as well as at the 30-day follow-up (31,0 % vs 13,2 % and 33,2 % vs 15,9 %, p < 0,001). Our findings suggest that both early and late interventions demonstrated similar beneficial outcomes in terms of myocardial recovery. Intervention in late presenter STEMI has been proven beneficial whether performed early or late.