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Comparison of long-term prognostic evaluation between pre-intervention thrombolysis and primary coronary

Tomonori Itoh1, Ken'ichi Fukami, Tomomi Suzuki

  • 1Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka 020-8505, Japan. t_itoh@imu.ncvc.go.jp

Circulation Journal : Official Journal of the Japanese Circulation Society
|June 24, 2010
PubMed

Insights

Primary percutaneous coronary intervention (PCI) offers superior long-term outcomes for ST-elevation myocardial infarction (STEMI) patients compared to pre-treatment thrombolysis. Facilitated PCI may provide similar effectiveness to primary PCI in STEMI management.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Acute Coronary Syndromes

Background:

  • Limited data exists on the comparative efficacy of primary percutaneous coronary intervention (PCI) versus pre-intervention thrombolysis with facilitated PCI in Japanese ST-elevation myocardial infarction (STEMI) patients.
  • Evaluating acute and long-term prognostic differences is crucial for optimizing STEMI treatment strategies.

Purpose of the Study:

  • To compare the outcomes of primary PCI versus pre-treatment with tissue-type plasminogen activator (t-PA) followed by facilitated PCI in Japanese STEMI patients.
  • To assess differences in coronary patency, left ventricular ejection fraction (LVEF), and major adverse cardiac event (MACE)-free rates.

Main Methods:

  • A randomized study involving 101 STEMI patients.
  • Patients were assigned to either primary PCI or pre-treatment with t-PA (prior-t-PA group).
  • The prior-t-PA group was further divided into facilitated PCI and prior-t-PA alone subgroups for analysis.

Main Results:

  • The prior-t-PA group showed significantly higher initial patency rates and 6-month LVEF compared to the primary-PCI group (P<0.001 and P=0.01, respectively).
  • However, the 5-year MACE-free rate was significantly lower in the prior-t-PA group (58.7%) versus the primary-PCI group (80.9%, P=0.03).
  • Facilitated PCI demonstrated comparable MACE-free rates to primary PCI (73.7% vs 80.9%, P=0.39), while prior-t-PA alone had a significantly lower MACE-free rate (48.1%, P=0.01).

Conclusions:

  • Primary PCI demonstrates superior long-term prognostic benefits over pre-intervention thrombolysis in STEMI patients.
  • Facilitated PCI emerges as a potentially effective alternative, offering outcomes similar to primary PCI for STEMI management.
Abstract

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