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Published on: May 28, 2019
[Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction With ST-Segment Elevation After
I S Bessonov1, V A Kuznetsov1, I P Zyryanov1
11Affiliate of the Cardiology Research Institute Cardiology Center, Tyumen, Russia; 2Central State Medical Academy, President Management Department RF, Moscow, Russia.
Insights
Primary PCI is clinically and economically justified in hospitals equipped for it. A pharmacoinvasive strategy, involving prehospital thrombolysis followed by PCI, showed no significant reduction in major cardiac events compared to primary PCI.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute ST-elevation myocardial infarction (STEMI) requires rapid reperfusion therapy.
- Percutaneous coronary intervention (PCI) and prehospital thrombolysis are key treatment modalities.
- Evaluating the effectiveness of a pharmacoinvasive strategy versus primary PCI in real-world settings is crucial.
Purpose of the Study:
- To analyze the outcomes of percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction (STEMI) who received prehospital thrombolysis.
- To compare the results of a pharmacoinvasive strategy (prehospital thrombolysis followed by PCI) with primary PCI (PPCI) in STEMI patients.
Main Methods:
- A comparative study involving 144 patients in the pharmacoinvasive group (PhG) and 577 in the primary PCI group (PPCIG) from 2008 to 2013.
- Patients in the PhG received tenecteplase for prehospital thrombolysis followed by PCI.
- Outcomes including composite events (death, reinfarction, stent thrombosis) and bleeding complications were assessed.
Main Results:
- The pharmacoinvasive group (PhG) included younger male patients with less frequent complete infarct-related artery occlusion compared to the primary PCI group (PPCIG).
- No significant differences were observed between the groups in composite outcomes or bleeding complications.
- Major cardiac complications during hospitalization were associated with older age, prior myocardial infarction, and total artery occlusion.
Conclusions:
- Primary PCI is clinically and economically justified in hospitals with PCI capabilities.
- A pharmacoinvasive strategy did not demonstrate a reduction in major cardiac events compared to primary PCI in this real-world clinical practice analysis.
Purpose:
to analyze results of percutaneous coronary intervention (PCI) in patients with acute ST- elevation myocardial infarction performed after prehospital thrombolysis in real clinical practice.
Material:
In the period from 2008 to 2013 144 and 577 patients were subjected to PCI after prehospital thrombolysis with tenecteplase (pharmacoinvasive group - PhG) and primary PCI (PPCIG), respectively.
Results:
PhG compared with PPCIG contained younger patients (mean age 56.9+/-0.2 and 59.6+/-1.2 years, respectively; p=0.01), and higher portion of men (84.7 and 72.6%, respectively; p=0.003). Frequency of complete occlusion of infarct-related artery in PhG was lower (41.7 and 71.4%, respectively; p< 0.001). Time from onset of pain to administration of a thrombolytic drug was 80 (55; 172) min, PCI was performed in 270 (120; 540) min after thrombolysis. In PPCIG time from onset of symptoms to hospital admission was 120 (60; 230) min, "door-to-balloon" time - 86 (67; 115) min. There was no difference between groups in the composite outcome comprising death, recurrent infarction and stent thrombosis, as well as in frequency of bleeding complications at the puncture site. Rate of major cardiac complications during hospital stay was independently associated with elderly age (odds ratio [OR 1.05; 95% confidence interval [CI] 1.02 to 1.08), previous myocardial infarction (OR 2.21, 95% CI 1.18 to 4.18), and total occlusion of infarct-related artery (OR 4.08, 95%Cl 1.86 to 8.94). Pharmacoinvasive strategy was not associated with reduction of the incidence of major cardiac events (OR 1.25, 95%CI 0.60 to 2.60).
Conclusion:
In settlements with PCI capable hospital primary PCI is clinically and economically justified.Key words: myocardial infarction; pharmacoinvasive strategy; primary percutaneous coronary intervention; prehospital thrombolysis.
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