Early versus delayed percutaneous coronary revascularization in patients with concomitant sepsis and non-ST elevation myocardial infarction.

BACKGROUND

The prognosis of patients with concomitant sepsis and severe coronary artery disease (CAD) who develop acute myocardial infarction (AMI) is poor. While percutaneous coronary intervention (PCI) can improve survival in AMI during and post sepsis, the decision is complex due to high mortality rates and increased risk of complications. The optimal timing of intervention for these patients, once clinically indicated, remains controversial, with specific recommendations for revascularization lacking in current guidelines. This retrospective analysis investigates and compares clinical outcomes of early PCI strategy (<72 h from diagnosis of MI) versus delayed PCI strategy (≥72 h) in patients who were hospitalized with sepsis and concomitantly developed AMI.

METHODS

This multicenter retrospective study included 217 hospitalized patients with sepsis and AMI who underwent PCI after sepsis treatment, from January 2016 to May 2024. Patients with ST-elevation myocardial infarctions and non-obstructive CAD were excluded. Of these, 75 patients received early PCI, and 142 underwent delayed PCI. We analyzed in-hospital all-cause mortality, major cardiovascular events, progression to shock, length of stay, and readmission rates at 45 days and 1 year.

RESULTS

The mean peak serum troponin I level in the early revascularization cohort was higher (13.1 ng/mL vs. 7.8 ng/mL; P < 0.01). Baseline characteristics were otherwise similar. There was significantly higher all-cause mortality (16% vs. 3.5%; P < 0.01) associated with early PCI in patients with concomitant sepsis. However, a delayed invasive strategy was associated with a 28% longer length of stay (14.6 days vs. 11.4 days) and a greater likelihood of progression to shock (RR 1.41). There were no major differences in 45-day and 1-year readmission rates between the cohorts.

CONCLUSIONS

In patients with non-ST elevation myocardial infarction in the context of sepsis, early PCI was associated with higher all-cause mortality compared to delayed PCI. The delayed PCI cohort had longer lengths of stay; however, these findings may be attributable to the lower mortality in this group. This study suggests that in select patients with concomitant MI and sepsis, it may not be unreasonable to prioritize treating the sepsis prior to attempting revascularization. However, major limitations exist in the study and a randomized controlled trial is warranted to further investigate these findings.