Impact of Early Percutaneous Coronary Intervention on Long-Term Survival in Patients With Acute Myocardial Infarction

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 PCI (≤24 hours) compared with delayed or no PCI on short- and long-term clinical outcomes. MATERIALS AND METHODS: A five-year mixed cohort study was conducted and included 891 consecutive AMI 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 myocardial infarction (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 used to adjust for confounding. Statistical analyses were done in the IBM SPSS Statistics software, version 27.0 (IBM Corp., Armonk, NY, USA). Results: Early PCI was associated with lower in-hospital mortality (18/446, 4.0% vs 35/445, 7.9%; p = 0.01), shorter door-to-balloon time (median 65 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-up of 48 months, early PCI 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), HF hospitalization (56/446, 12.6% vs 84/445, 18.9%; adjusted HR 0.66, 95% CI 0.47-0.93, p = 0.02), and MACE (92/446, 20.6% vs 138/445, 31.0%; adjusted HR 0.63, 95% CI 0.49-0.82, p < 0.001). Recurrent MI was slightly lower with early PCI (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 PCI confers substantial short- and long-term survival benefits in AMI patients, with significant reductions in all-cause and cardiovascular mortality, HF hospitalization, and MACE. These findings underscore the critical importance of timely reperfusion, supporting guideline-driven early PCI strategies in real-world practice.