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A comparison of rescue and primary percutaneous coronary interventions for acute ST elevation myocardial infarction
M B Faslur Rahuman1, Jayanthimala B Jayawardena1, George R Francis1
1Institute of Cardiology, National Hospital of Sri Lanka, Colombo, Sri Lanka.
Insights
Rescue percutaneous coronary intervention (PCI) is a viable option for ST-elevation myocardial infarction (STEMI) patients lacking immediate PCI access. In-hospital outcomes, including major adverse cardiac events and mortality, were comparable between rescue PCI and primary PCI strategies.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Myocardial Infarction Management
Background:
- ST-elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
- Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy.
- Access to primary PCI facilities can be limited in certain regions.
Purpose of the Study:
- To compare in-hospital outcomes of rescue PCI versus primary PCI in STEMI patients.
- To evaluate the feasibility of rescue PCI for patients without immediate primary PCI access.
Main Methods:
- A comparative analysis of 159 STEMI patients undergoing either rescue PCI or primary PCI.
- Patients were selected from the National Hospital of Sri Lanka between March 2013 and April 2015.
- In-hospital results were analyzed, comparing key procedural and clinical outcomes.
Main Results:
- The left anterior descending artery was a more frequent culprit vessel in the rescue PCI group.
- No significant differences were observed in left ventricular dysfunction or multivessel disease prevalence.
- Procedural success rates and in-hospital mortality were similar between rescue and primary PCI groups.
Conclusions:
- Rescue PCI demonstrates comparable in-hospital outcomes to primary PCI in STEMI management.
- Rescue PCI serves as a practical alternative for patients with limited access to primary PCI facilities.
- Major adverse cardiac events were similar across both intervention strategies.
Objective:
To perform a comparative analysis of in-hospital results obtained from patients with acute ST elevation myocardial infarction (STEMI), who underwent rescue or primary percutaneous coronary intervention (PCI). The aim is to determine rescue PCI as a practical option for patients with no immediate access to primary PCI.
Methods:
From the Cardiology PCI Clinic of the National Hospital of Sri Lanka (NHSL), we selected all consecutive patients presenting with acute STEMI
Results:
We evaluated 159 patients; 78 underwent rescue PCI and 81 underwent primary PCI. The culprit left anterior descending (LAD) vessel (76.9% vs. 58.8%; P=0.015) was more prevalent in rescue than in primary patients. Thrombus aspiration was less frequent in rescue group (19.2% vs. 40.7%; p=0.004). The degree of moderate-to-severe left ventricular dysfunction reflected by the ejection fraction <40% (24.3% vs. 23.7%; P=0.927) and prevalence of multivessel disease (41.0% vs. 43.8%; P=0.729) revealed no significant difference. Coronary stents were implanted at similar rates in both strategies (96.2% vs. 92.6%; P=0.331). Procedural success (97.4% vs. 97.5%; P=0.980) and mortality rates (5.1% vs. 3.8%; P=0.674), were similar in the rescue and primary groups.
Conclusion:
In-hospital major adverse cardiac events (MACE) are similar in both rescue and primary intervention groups, supporting the former as a practical option for patients with no immediate access to PCI facilities.