Impact of Early Percutaneous Coronary Intervention on Long-Term Survival in Patients With Acute Myocardial InfarctionCureus 18(1): e101145. DOI 10.7759/cureus.101145

Abstract

Background: Early percutaneous coronary intervention(PCI) is the recommended standard of care for acute myocardial infarction (AMI), but long-term outcomes in mixed real-world cohorts remain underreported. This study evaluated the effects of early percutaneous coronary intervention (≤24 hours) compared with delayed or no percutaneous coronary intervention on short- and long-term clinical outcomes.

Materials and methods: A five-year mixed cohort studywas conducted and included 891 consecutive acute myocardial infarction patients (early PCI, n = 446;delayed/no PCI, n = 445). Demographics, clinical characteristics, procedural data, and in-hospital outcomes were collected. Long-term outcomes, such as all-cause mortality, cardiovascular mortality, recurrent myocardialinfarction (MI), heart failure (HF) hospitalization, and major adverse cardiovascular events (MACE), were assessed over a median follow-up of 48 months. Propensity score matching and Cox proportional hazards models were usedto adjust for confounding. Statistical analyses were done in the IBM SPSS Statistics software, version 27.0 (IBM Corp., Armonk, NY, USA).

Results: Early percutaneous coronary intervention wasassociated with lower in-hospital mortality (18/446, 4.0% vs 35/445, 7.9%; p = 0.01), shorter door-to-balloon time (median65 vs 210 minutes; p < 0.001), and better left ventricular function (mean left ventricular ejection fraction (LVEF) 48.7% vs 46.2%; p < 0.001). Over a median follow-upof 48 months, early percutaneous coronary intervention significantly reduced all-cause mortality (62/446,13.9% vs 112/445, 25.2%; adjusted hazard ratio (HR) 0.54, 95% CI 0.40-0.73, p < 0.001), cardiovascular mortality (44/446, 9.9% vs 82/445, 18.4%; adjusted HR 0.53, 95% CI 0.37-0.77, p = 0.001), heart failure hospitalization (56/446, 12.6% vs 84/445, 18.9%; adjusted HR 0.66, 95% CI 0.47-0.93, p = 0.02), and major adverse cardiovascular events (92/446,20.6% vs 138/445, 31.0%; adjusted HR 0.63, 95% CI 0.49-0.82, p < 0.001). Recurrent myocardial infarction was slightly lower with early percutaneous coronary intervention (38/446,8.5% vs 49/445, 11.0%; adjusted HR 0.78, 95% CI 0.52-1.16, p = 0.21) but did not reach statistical significance.

Conclusion:Early percutaneous coronary intervention confers substantial short- and long-term survival benefits in acute myocardial infarction patients, with significant reductions in all-cause and cardiovascular mortality, heart failure hospitalization, and major adverse cardiovascular events. These findingsunderscore the critical importance of timely reperfusion, supporting guideline-driven early percutaneous coronary intervention strategies in real-world practice.

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