Pharmacoinvasive therapy for ST elevation myocardial infarction in China: a pilot study

Area of Science:

• Cardiology
• Interventional Cardiology
• Emergency Medicine

Background:

• Primary percutaneous coronary intervention (PCI) is the preferred treatment for ST-elevation myocardial infarction (STEMI).
• Timely PCI is often unavailable for STEMI patients due to logistical challenges, necessitating alternative reperfusion strategies.
• Early routine PCI following thrombolysis is a potential strategy to improve outcomes in selected STEMI patients.

Purpose of the Study:

• To investigate the feasibility and safety of early percutaneous coronary intervention (PCI) after successful half-dose alteplase reperfusion in Chinese STEMI patients.
• To assess the impact of early PCI on epicardial blood flow and myocardial perfusion.
• To evaluate short-term clinical outcomes following this treatment strategy.

Main Methods:

• STEMI patients with an expected delay to PCI of ≥90 minutes received half-dose alteplase.
• Eligible patients underwent diagnostic angiography 3-24 hours after thrombolysis, with PCI performed for residual stenosis ≥70%.
• Epicardial flow (TIMI flow grade, TIMI frame count) and myocardial perfusion (myocardial blush grade, TIMI myocardial perfusion frame count) were assessed.

Main Results:

• Forty-nine patients underwent angiography, with 46 receiving PCI.
• PCI significantly improved TIMI flow grade (47.8% to 71.7% TIMI 3) and TIMI frame count (48.5 to 37.9, P=0.01).
• Myocardial perfusion showed an improving trend post-PCI; best perfusion occurred 3-12 hours after lysis. No major bleeding or stroke occurred; two deaths and four composite endpoint events were observed within 30 days.

Conclusions:

• Early routine PCI following half-dose alteplase thrombolysis appears feasible and safe in a Chinese STEMI population.
• The strategy demonstrated improvements in coronary blood flow and myocardial perfusion.
• Larger clinical trials are warranted to confirm the efficacy and safety of this approach.