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Thrombolysis Followed by Early Percutaneous Coronary Intervention via Transradial Artery Approach in Patients with
Yan-Bo Wang1, Xiang-Hua Fu1, Xin-Shun Gu1
1Department of Cardiology, Second Hospital of Hebei Medical University, Shijiazhuang 050000, P.R. China.
Insights
Thrombolysis followed by early percutaneous coronary intervention (PCI) is safe and effective for ST-segment elevation myocardial infarction (STEMI) patients. This approach, utilizing the transradial artery, showed comparable outcomes to primary PCI regarding major adverse cardiac events.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- ST-segment elevation myocardial infarction (STEMI) is a critical condition requiring rapid reperfusion.
- Thrombolysis followed by percutaneous coronary intervention (PCI) is a treatment strategy for STEMI.
- The transradial artery approach is increasingly used for PCI procedures.
Purpose of the Study:
- To investigate the safety and efficacy of thrombolysis followed by early PCI in STEMI patients.
- To compare outcomes between early PCI (E-PCI) and primary PCI (P-PCI) groups.
Main Methods:
- 161 STEMI patients were divided into E-PCI (thrombolysis in a non-PCI hospital followed by immediate transfer for PCI) and P-PCI groups.
- Coronary angiography and PCI were performed via the transradial artery approach in both groups.
- Comparison of angiographic parameters, bleeding complications, hospital stay, and 30-day major adverse cardiac events (MACE).
Main Results:
- The E-PCI group showed better myocardial reperfusion with a lower thrombus score and higher TIMI flow grade 3 before PCI.
- Higher left ventricular ejection fraction (LVEF) before discharge was observed in the E-PCI group (p=0.028).
- No significant differences in bleeding complications, hospital stay, or 30-day MACE between the groups.
Conclusions:
- Thrombolysis followed by early PCI via the transradial artery approach is safe and efficacious for STEMI patients.
- This strategy achieves comparable clinical outcomes to primary PCI.
- Predictors of MACE include hyperlipidemia, smoking, low pre-PCI TIMI flow, and low LVEF.
Background:
The purpose of this study was to investigate the safety and efficacy of thrombolysis followed by early percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI).
Methods:
A total of 161 patients were enrolled in the study. Fifty-three of them who underwent thrombolysis in non-PCI hospital and immediately transferred to receive early PCI were assigned to the early PCI group (E-PCI); the rest of the patients were assigned to the primary PCI group (P-PCI). Coronary angiography and PCI were performed via the transradial artery approach for patients in both groups. Angiographic parameters, bleeding complications and total hospital stay were compared between the two groups. All patients were followed-up for 30 days to evaluate major adverse cardiac events (MACE).
Results:
Before PCI procedure, the thrombus score of IRA in the E-PCI group was lower, and the percentage of TIMI flow grade (TFG) 3 was higher (both p < 0.05) compared to those in the P-PCI group. The myocardial reperfusion in the E-PCI group was better than that in the P-PCI group. There was a trend towards a lower peak value of serum creatine kinase MB in the E-PCI group, and left ventricular ejection fraction (LVEF) before discharge in E-PCI was higher than that in the P-PCI group (54.38 ± 5.29% vs. 52.19 ± 7.00%, respectively, p = 0.028). No significant differences were found in the incidences of bleeding complications and hospital stay between the two groups. There was no significant difference in the 30-day MACE between the two groups (p = 0.863), and no significance of cumulative MACE-free survival rates were found between the two groups as well (p = 0.522). Variables predicting MACE upon patient follow-up according to univariable Cox regression analyses showed that a history of hyperlipidemia, smokers, TFG of infarction related artery before PCI < 2, and low levels of LVEF were associated with poor clinical outcomes (all p < 0.05).
Conclusions:
It is safe and efficacious for STEMI patients to receive thrombolysis followed by early PCI via the transradial artery approach.
Key Words:
Major adverse cardiac event; Percutaneous coronary intervention; Radial artery; ST-segment elevation myocardial infarction; Thrombolysis.
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