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Updated: Aug 19, 2025
Postconditioning with Lactate-enriched Blood for Cardioprotection in ST-segment Elevation Myocardial Infarction
Published on: May 28, 2019
Late outcomes of ST-elevation myocardial infarction treated by pharmaco-invasive or primary percutaneous coronary
Javeria Jamal1,2,3, Hanan Idris1,4,5, Amir Faour1,3
1Department of Cardiology, Elizabeth Street, Liverpool Hospital, Sydney, NSW 2170, Australia.
Insights
Pharmaco-invasive percutaneous coronary intervention (PI-PCI) offers better outcomes than late primary PCI (pPCI) for ST-elevation myocardial infarction (STEMI) patients. PI-PCI should be considered when timely pPCI is not feasible, even if rescue PCI is needed.
Area of Science:
- Cardiology
- Interventional Cardiology
- Acute Coronary Syndromes
Background:
- Pharmaco-invasive percutaneous coronary intervention (PI-PCI) is recommended for ST-elevation myocardial infarction (STEMI) patients unable to undergo timely primary PCI (pPCI).
- This study compares late outcomes of PI-PCI with timely and late pPCI.
Purpose of the Study:
- To evaluate the late outcomes of a pharmaco-invasive strategy versus primary PCI in STEMI patients.
- To determine if PI-PCI offers a survival benefit compared to delayed pPCI.
Main Methods:
- Retrospective analysis of 2091 STEMI patients undergoing PCI between October 2003 and March 2014.
- Patients were categorized into timely pPCI, late pPCI, and PI-PCI (scheduled or rescue).
- Propensity matching was used to compare mortality rates at 3 years.
Main Results:
- 3-year mortality was significantly lower with PI-PCI (6.2%) compared to pPCI (11.1%) (P < 0.01).
- Late pPCI was associated with higher mortality (20.2%) than timely pPCI (6.7%).
- Adjusted analyses showed lower mortality for scheduled PCI vs. rescue PCI, and both were better than late pPCI.
Conclusions:
- A pharmaco-invasive strategy is associated with better survival outcomes than late primary PCI in STEMI patients.
- PI-PCI should be considered when delays to primary PCI are anticipated.
- Even with a need for rescue PCI in a third of cases, PI-PCI demonstrates superior outcomes to late pPCI.
Aims:
Pharmaco-invasive percutaneous coronary intervention (PI-PCI) is recommended for patients with ST-elevation myocardial infarction (STEMI)who are unable to undergo timely primary PCI (pPCI). The present study examined late outcomes after PI-PCI (successful reperfusion followed by scheduled PCI or failed reperfusion and rescue PCI)compared with timely and late pPCI (>120 min from first medical contact).
Methods And Results:
All patients with STEMI presenting within 12 h of symptom onset, who underwent PCI during their initial hospitalization at Liverpool Hospital (Sydney), from October 2003 to March 2014, were included. Amongst 2091 STEMI patients (80% male), 1077 (52%)underwent pPCI (68% timely, 32% late), and 1014 (48%)received PI-PCI (33% rescue, 67% scheduled). Mortality at 3 years was 11.1% after pPCI (6.7% timely, 20.2% late) and 6.2% after PI-PCI (9.4% rescue, 4.8% scheduled); P < 0.01. After propensity matching, the adjusted mortality hazard ratio (HR) for timely pPCI compared with scheduled PCI was 0.9 (95% CIs 0.4-2.0) and compared with rescue PCI was 0.5 (95% CIs 0.2-0.9). The adjusted mortality HR for late pPCI, compared with scheduled PCI was 2.2 (95% CIs 1.2-3.1)and compared with rescue PCI, it was 1.5 (95% CIs 0.7-2.0).
Conclusion:
Patients who underwent late pPCI had higher mortality rates than those undergoing a pharmaco-invasive strategy. Despite rescue PCI being required in a third of patients, a pharmaco-invasive approach should be considered when delays to PCI are anticipated, as it achieves better outcomes than late pPCI.
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