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Primary percutaneous transluminal coronary intervention compared with intravenous thrombolysis in patients with ST
Wiwun Tungsubutra1, Damras Tresukosol, Rungroj Krittayaphong
1Department of Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand. siwts@mahidol.ac.th
Insights
Primary percutaneous coronary intervention (PCI) and thrombolytic therapy (TT) are comparable reperfusion strategies for ST-segment elevation myocardial infarction (STEMI). While in-hospital mortality is similar, PCI may be preferred for patients at higher risk of bleeding or stroke.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Acute ST-segment elevation myocardial infarction (STEMI) requires prompt reperfusion.
- Primary percutaneous transluminal coronary intervention (PCI) and thrombolytic therapy (TT) are established reperfusion methods.
- Comparing outcomes of PCI versus TT in STEMI patients is crucial for treatment selection.
Purpose of the Study:
- To compare in-hospital outcomes between primary PCI and TT in acute STEMI patients.
- To evaluate the efficacy and safety of different reperfusion strategies.
Main Methods:
- Prospective data collection from August 2002 to June 2004 for STEMI patients receiving reperfusion therapy.
- Analysis of demographics, procedures, medications, and in-hospital outcomes.
- Comparison of 91 patients treated with primary PCI and 55 patients treated with TT.
Main Results:
- No significant difference in in-hospital mortality between primary PCI (14.3%) and TT (10.9%) groups.
- Similar baseline characteristics, including diabetes prevalence and cardiogenic shock on admission.
- A trend towards higher rates of major bleeding and stroke in the TT group, though not statistically significant.
Conclusions:
- Primary PCI and TT are comparable reperfusion strategies for STEMI regarding in-hospital mortality.
- Primary PCI may be advantageous in specific subgroups at increased risk for bleeding or stroke.
- Treatment decisions should consider individual patient risk factors.
Background:
Primary percutaneous transluminal coronary intervention (PCI) and thrombolytic therapy (TT) are alternative means of achieving reperfusion in patients with acute ST segment elevation myocardial infarction (STEMI).
Objective:
To compare the outcomes between both reperfusion strategies. The authors sought to compare in-hospital outcomes after PCI or TT for patients with acute STEMI.
Material And Method:
From August 2002 through June 2004, data from all patients who received reperfusion therapy for acute STEMI were collected prospectively. The decision regarding type of reperfusion strategy was at the attending cardiologist's discretion. The patient's data on demographics, procedures, medications, and in-hospital outcomes were analyzed.
Results:
From August 2002 through June 2004, 234 patients were admitted to the authors' institute with the diagnosis of acute STEMI. Of the 146 patients who received reperfusion therapy, 91 were treated with primary PCI and 55 received intravenous TT as the reperfusion modality. In the TT group, 51 (93%) patients received streptokinase and 11 (21.6%) underwent rescue angioplasty. The two groups had similar baseline characteristics. Both patient groups had frequent presence of diabetes (PCI 44.2% vs. TT 39.6%, p = 0. 6). Cardiogenic shock on admission was present in 11% of the PCI patients and 7.3% of the TT patients (p = ns). In-hospital mortality was not significantly different in the two groups (PCI 14.3% vs. TT 10. 9%, p = 0.56). In the TT group, there was a trend toward a higher rate of major bleeding (PCI 6.6% vs. TT 16.4%, p = 0.06) and stroke (PCI 2.2% vs. TT 7.3%, p = 0.13) complications without statistical significance.
Conclusion:
The present findings suggest that both PCI and TT are comparable alternative methods of reperfusion among STEMI patients in terms of in-hospital mortality. In certain subgroups that are at increased risk of bleeding or stroke, primary PCI may be the preferred treatment strategy.
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