Late outcomes of ST-elevation myocardial infarction treated by pharmaco-invasive or primary percutaneous coronary...

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.