Should you receive a percutaneous coronary intervention if you present late with a heart attack?

This paper studied the outcomes of percutaneous coronary intervention in patients who presented late with a heart attack.

A heart attack occurs when there is a lack of blood supply to the heart. It is important to restore blood supply within 12 hours from the onset of symptoms. Without a constant supply of blood, heart muscles die. Over time, the heart remodels (changes in size and structure). Remodelling of the heart increases the risk of heart failure. For patients who present late to the hospital, it is not clear what treatment should be given.

Percutaneous coronary intervention is a procedure which is used to treat narrowed blood vessels. It is done after a heart attack to open up blocked blood vessels. It is not clear whether this is useful in patients who present late following a heart attack.

1090 patients who presented to the hospital more than 24 hours from having symptoms of a heart attack were studied. The structure and function of patients' hearts were analyzed. 786 patients had undergone late-percutaneous coronary intervention and 304 patients had been treated with the standard medical treatment. 

Overall, 53.9% of patients had significant remodelling of the left ventricle of the heart.

There was greater left ventricular remodelling in patients who did not receive percutaneous coronary intervention than iin patients who did. Patients who did not receive percutaneous coronary intervention also had a greater left ventricular size. Percutaneous coronary intervention for patients who presented late reduced the risk of occurrence of left ventricular remodelling by 65%.

During an average follow-up of 36 months, 389 patients had a major adverse event (undesired effect of treatment) associated with the heart, with 201 deaths. A late percuataneous coronary intervention was associated with a 50% lower risk of a major adverse event associated with the heart. It was also associated with a 59% reduced risk of death and a 42% reduced risk of rehospitalization for heart failure. 

The authors concluded that a late-percutaneous coronary intervention prevents left ventricular remodelling and improves clinical outcomes. 

Talk to your doctor about treatment options available following a heart attack.