Abstract 4137274: Optimal Timing of Pharmacoinvasive Strategy and its Impact on Clinical in Patients with ST-Elevation Myocardial Infarction: a Real-World Perspective

Background: Pharmacoinvasive strategy remains the cornerstone therapy for ST-elevation myocardial infarction (STEMI) where primary percutaneous coronary intervention (PCI) is unfeasible. Guidelines recommend PCI within 2 to 24 hours post-fibrinolysis. However, meta-analysis suggests that a shorter interval (<4h) between fibrinolysis and PCI (lysis-PCI time) significantly reduces the 30-day risk of death and reinfarction. Real-world applicability is limited due to trial exclusions of elderly patients and those with chronic kidney disease. This study aims to evaluate the impact of lysis-PCI timing on in-hospital mortality and major adverse cardiovascular events (MACE). Hypothesis: We hypothesize that shorter lysis-PCI times (<9h) increase in-hospital mortality and MACE, especially in patients over 80 years. Goals: To determine the impact of lysis-PCI timing on in-hospital mortality and MACE in STEMI patients. Methods: This retrospective cohort study of 1,043 STEMI patients in Brasília, Brazil, used multivariable categorical logistic regression models to assess the association of three lysis-PCI intervals (<9h; 9-18h; >18h) with in-hospital mortality and 4p-MACE (death, acute myocardial infarction, stroke, heart failure). Propensity score matching (1:1) was used to adjust for cardiovascular risk factors. Statistical significance was set at p<0.05. Results: The lysis-PCI timing groups showed no significant differences in admission Killip class, GRACE score, or age. However, the <9h group had higher incidences of in-hospital mortality (p=0.004), heart failure (p=0.002), cardiogenic shock (p=0.001), cardiac arrest within 24 hours (p=0.003), minor bleeding (p=0.006), and MACE (p=0.002). Multivariable categorical logistic regression revealed that each 4-h delay in lysis-PCI time reduced the risk of death (HR 0.560, 95% CI 0.381-0.771; p=0.001) and MACE (HR 0.877, 95% CI 0.811-0.948; p=0.001). These findings remained consistent after propensity score analysis (death: HR 0.721, 95% CI 0.516-0.956; p=0.034). Among patients older than 80, shorter lysis-PCI times were associated with increased mortality and MACE, even after propensity adjustment (Figure 1). Conclusion(s): Shorter lysis-PCI times (<9h) are associated with higher in-hospital mortality and MACE across all age groups, with a pronounced effect in patients over 80 years. These findings underscore the need for careful consideration of lysis-PCI timing, especially in elderly populations.