Pharmacoinvasive Strategy vs Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Study in Mexico City
Diego Araiza-Garaygordobil1, Rodrigo Gopar-Nieto1, Alejandro Cabello-López2
1Cardiovascular Critical Care Unit, Instituto Nacional de Cardiología "Ignacio Chávez," Mexico City, México.
Insights
For ST-elevation myocardial infarction (STEMI) patients, a pharmacoinvasive strategy (PIs) showed similar cardiovascular outcomes and bleeding risk compared to primary percutaneous coronary intervention (PCI). PIs is a safe and effective reperfusion option when timely PCI is unavailable.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Limited reperfusion therapy access for ST-elevation myocardial infarction (STEMI) in low- to middle-income countries.
- Primary percutaneous coronary intervention (PCI) is preferred, but pharmacoinvasive strategy (PIs) is a viable alternative when timely PCI is not feasible.
Purpose of the Study:
- To evaluate the efficacy and safety of a pharmacoinvasive strategy (PIs) compared to primary PCI in a real-world setting for STEMI patients.
- To assess cardiovascular outcomes and bleeding events in STEMI patients undergoing different reperfusion strategies.
Main Methods:
- Prospective registry of 579 STEMI patients receiving reperfusion within 12 hours of symptom onset.
- Primary endpoint: composite of cardiovascular death, cardiogenic shock, recurrent MI, or heart failure at 30 days.
- Safety endpoint: major bleeding (BARC score 3-5) at 30 days.
Main Results:
- No significant difference in the primary composite endpoint between PIs and primary PCI groups (HR 0.76; P=0.24).
- Major bleeding rates were similar between the PIs and primary PCI groups (HR 0.92; P=0.81).
- Intracranial bleeding occurred in 0.6% of the PIs group versus 0% in the PCI group (P=0.15).
Conclusions:
- Pharmacoinvasive strategy (PIs) demonstrated comparable major cardiovascular outcomes and bleeding risk to primary PCI in STEMI patients.
- PIs is an effective and safe reperfusion option for STEMI patients, particularly when primary PCI access is limited.
Background:
A low proportion of patients with ST-elevation myocardial infarction (STEMI) in low- to middle-income countries receive reperfusion therapy. Although primary percutaneous coronary intervention (PCI) is the method of choice, a pharmacoinvasive strategy (PIs) is reasonable when primary PCI cannot be delivered on a timely basis. The aim of our study was to assess the efficacy and safety of a PIs compared with primary PCI in a real-world setting.
Methods:
This was a prospective registry that included patients with STEMI who received reperfusion during the first 12 hours from symptom onset. The primary composite end point was the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure at 30 days according to the reperfusion strategy used. The key safety end point was major bleeding (Bleeding Academic Research Consortium [BARC] score 3-5) at 30 days.
Results:
We included 579 patients with STEMI, 49.7% underwent primary PCI and 50.2% received PIs. Those who received a PIs approach were more likely to present with Killip class > 1 and to have a history of diabetes but were less likely to have a previous cardiovascular disease diagnosis. No statistically significant difference was shown in the primary composite end point according to reperfusion strategy (hazard ratio for PIs, 0.76; 95% confidence interval, 0.48-1.21; P = 0.24). Major bleeding was not different among groups (hazard ratio for PIs, 0.92; 95% confidence interval, 0.45-1.86; P = 0.81). Two patients in the PIs group (0.6%) and no patients in the PCI group had intracranial bleeding (P = 0.15).
Conclusions:
In this prospective real-world registry, major cardiovascular outcomes and bleeding were not different among patients who underwent a PIs or primary PCI. The study suggests that a PIs is an effective and safe option for patients with STEMI when access to primary PCI is limited.
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