Table 17.

Principles in Late presenters.

•Given the complexity and variety of possible factors in the spectrum of stable patients presenting late with acute myocardial infarction, we propose a patient-tailored approach and a management strategy based on the existing limited evidence.

•Late revascularization presents special challenges to the interventional cardiologist, requiring careful analysis of patient and angiographic variables to determine the most appropriate strategy

In patients presenting beyond 24 h

•Patients presenting with hypotension, pulmonary edema, electrical instability and ongoing ischemia should undergo coronary angiogram and revascularization.

•Stable patients with diabetes and LVEF <40% should undergo a coronary angiogram for risk stratification. A PCI may be appropriate if patent (<100%) but having significant narrowing of IRA is identified.

•A totally occluded IRA in asymptomatic patients should be opened only if myocardial ischemia or viability is proven.

•Stable patients without diabetes and LV EF >40% should undergo a stress test prior to hospital discharge. Coronary angiogram and revascularization are recommended if high risk features, myocardial ischemia or viability are shown.

•Stable asymptomatic patients presenting beyond 3 days from symptom onset who have total occlusion of the IRA and no evidence of severe silent ischemia showed no difference between revascularization and conservative management in overall mortality or major adverse clinical events in the Open Artery Trial