การเปรียบเทียบระยะเวลาการขยายหลอดเลือดหัวใจแบบมาตรฐานกับแบบล่าช้า ในประสิทธิผลและอุบัติการณ์ของเหตุการณ์ไม่พึงประสงค์ร้ายแรงทางหัวใจ ในผู้ป่วยกล้ามเนื้อหัวใจขาดเลือดเฉียบพลันชนิดคลื่นไฟฟ้า ST ยกตัวที่ได้รับการวินิจฉัยเร็ว - การศึกษา SPEED-STEMI

Preechaphat Laphatphakkhanut

Authors

Preechaphat Laphatphakkhanut Department of medicine, Nakornping Hospital.

Keywords:

ST elevation myocardial infarction, STEMI, primary percutaneous coronary intervention, PPCI, early presenter STEMI, standard PPCI, delayed PPCI

Abstract

Background: Primary percutaneous coronary intervention (PPCI) is the standard treatment for ST-elevation myocardial infarction (STEMI) within 12 hours of symptom onset. However, the clinical benefit of achieving a diagnosis-to-PCI time ≤ 120 minutes, compared with delayed PCI within this period, remains uncertain for 30-day outcomes.

Objectives: To compare 30-day major adverse cardiac events (death, recurrent myocardial infarction, and heart failure) between early (≤ 120 minutes) and delayed (> 120 minutes) primary PCI in early-presenting STEMI

Methods: This single-center retrospective cohort study used data from the Nakornping Hospital STEMI Registry. Patients with STEMI presenting within 12 hours of symptom onset between October 1, 2024, and September 30, 2025, were included. Patients were stratified into early (≤ 120 minutes) and delayed (> 120 minutes) PPCI groups. The primary endpoint was 30-day major adverse cardiac events, defined as a composite of all-cause mortality, recurrent myocardial infarction, and heart failure.

Results: Among 210 early presenting STEMI patients, 137 (65.2%) were male, the mean age was 63.5 (± 12.2) years, and baseline characteristics were generally well balanced between the study groups. However, the delayed PPCI group exhibited a significantly higher prevalence of pre-existing coronary artery disease (20.4% vs. 9.8%, P = 0.036) and a higher trend of chronic kidney disease (15.7% vs. 6.9%, P = 0.052). Regarding clinical outcomes, the 30-day MACE rate was 11.9 % in the early PCI group compared to 19.0 % in the delayed group but not statistically significant (adjusted RR 1.30, 95% CI 0.68–2.48, p= 0.420). Notably, while a favorable trend toward lower all-cause mortality was observed in the early PPCI group (6.9% vs. 15.2%, P = 0.068), the incidences of recurrent myocardial infarction and heart failure remained comparable in both groups.

Conclusion: In early-presenter STEMI, achieving a standard or early PPCI time demonstrates a clinically meaningful, though not statistically significant, trend toward reduced 30-day mortality and major adverse cardiac events. These findings support the continued optimization of regional fast-track systems to ensure timely reperfusion for improved patient outcomes.

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