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Weaknesses in regional primary coronary angioplasty programs: is there still a role for a pharmaco-invasive approach?

Nicolas Danchin1, Nelson Dos Santos Teixeira1, Etienne Puymirat1

  • 1Département de Cardiologie, Hôpital Européen Georges Pompidou, Assistance Publique des Hôpitaux de Paris and Faculté de Médecine, Université Paris-Descartes, Paris, France.

Revista Espanola De Cardiologia (English Ed.)
|July 20, 2014
PubMed

Insights

The pharmaco-invasive strategy, combining fibrinolysis with timely intervention, offers a viable alternative to primary percutaneous coronary intervention for ST-elevation myocardial infarction patients. This approach improves outcomes and complements primary percutaneous coronary intervention networks.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Emergency Medicine

Background:

  • Primary percutaneous coronary intervention is the guideline-recommended reperfusion strategy for ST-elevation myocardial infarction (STEMI).
  • Initial trials compared primary percutaneous coronary intervention with intravenous fibrinolysis alone.
  • Subsequent research demonstrated improved outcomes with rescue percutaneous coronary intervention and routine angiography after fibrinolysis.

Purpose of the Study:

  • To evaluate the pharmaco-invasive strategy as an alternative to primary percutaneous coronary intervention for STEMI.
  • To assess the efficacy of the pharmaco-invasive strategy when primary percutaneous coronary intervention is delayed.
  • To explore the role of the pharmaco-invasive strategy in complementing existing STEMI treatment networks.

Main Methods:

  • Review of randomized trials, including the STREAM trial.
  • Analysis of real-world data, specifically the FAST-MI registry.
  • Comparison of pharmaco-invasive strategy outcomes with primary percutaneous coronary intervention.

Main Results:

  • The pharmaco-invasive strategy, when applied appropriately, shows favorable outcomes compared to primary percutaneous coronary intervention.
  • This strategy is a valid alternative when primary percutaneous coronary intervention cannot be performed within recommended timeframes.
  • Long-term data supports the effectiveness of the pharmaco-invasive approach.

Conclusions:

  • The pharmaco-invasive strategy is a crucial alternative for STEMI reperfusion, especially when primary percutaneous coronary intervention is not feasible.
  • Implementing pharmaco-invasive protocols can enhance the resilience and effectiveness of STEMI treatment networks.
  • This strategy offers a valuable option to improve patient outcomes in ST-elevation myocardial infarction care.

Keywords:
Estrategia farmacoinvasivaFibrinolisisFibrinolysisInfarto agudo de miocardio con elevación del segmento STIntervención coronaria percutánea primariaPharmaco-invasive strategyPrimary percutaneous coronary interventionST-segment elevation myocardial infarction

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