ST-segment elevation myocardial infarction for pharmacoinvasive strategy or primary percutaneous coronary
1Al Shifa Hospital, Gaza, Palestine.
Insights
Pharmacoinvasive treatment (Ph-PCI) showed better outcomes than primary percutaneous coronary intervention (P-PCI) for ST-segment elevation myocardial infarction (STEMI) patients, reducing heart failure and mortality. Ph-PCI also improved ST-segment resolution post-intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- Primary percutaneous coronary intervention (P-PCI) is the preferred reperfusion therapy for ST-segment elevation myocardial infarction (STEMI).
- Pharmacoinvasive treatment (Ph-PCI) serves as an alternative in hospitals without P-PCI capabilities.
- Comparative efficacy of Ph-PCI versus P-PCI in STEMI patients requires further investigation.
Purpose of the Study:
- To compare the efficacy of Ph-PCI versus P-PCI strategies in STEMI patients.
- To evaluate the composite endpoint of heart failure and total death at 30 days.
- To assess ST-segment elevation resolution 60 minutes after intervention.
Main Methods:
- Retrospective analysis of 308 STEMI patients presenting within 12 hours of symptom onset.
- Group 1 (154 patients): P-PCI within 90 minutes of first medical contact.
- Group 2 (154 patients): Ph-PCI 2-24 hours after thrombolytic treatment.
Main Results:
- The composite endpoint of heart failure and mortality was significantly lower in the Ph-PCI group (8.4%) compared to the P-PCI group (16.2%) (p=0.038).
- No significant difference was observed in 30-day total death rates between P-PCI (5.2%) and Ph-PCI (3.2%) (p=0.39).
- Heart failure rates were lower in the Ph-PCI group (5.2%) versus the P-PCI group (11%) (p=0.06).
- ST-segment resolution >50% at 60 minutes post-intervention was higher in the Ph-PCI group (76.2%) than in the P-PCI group (65%) (p=0.034).
Conclusions:
- Ph-PCI demonstrated a significant reduction in the composite endpoint of mortality and heart failure at 30 days post-STEMI.
- Ph-PCI was associated with improved ST-segment resolution within one hour after intervention compared to P-PCI.
- Ph-PCI is a viable and effective alternative reperfusion strategy for STEMI patients in non-P-PCI capable settings.
Introduction:
Primary percutaneous coronary intervention (P-PCI) is still preferred as the optimal reperfusion therapy among patients with ST-segment elevation myocardial infarction (STEMI). However, in non-PCI capable hospitals, pharmacoinvasive treatment (Ph-PCI) can be performed as alternative therapy to P-PCI. This study compares the efficacy between a Ph-PCI and P-PCI strategies among patients with STEMI.
Material And Methods:
We conducted a retrospective analysis of patients with STEMI presenting within 12 h of symptoms onset assigned to two groups: Group 1 (N = 154 patients) - P-PCI within 90 min after first medical contact; Group 2 (N = 154 patients) - Ph-PCI 2-24 h after completion of thrombolytic treatment in the emergency room at Alshifa Hospital in Gaza. Primary endpoint: a composite of heart failure and total death at 30 days. Secondary endpoint: the percentage resolution of ST-segment elevation 60 min after PCI.
Results:
In total, 308 patients presented with acute STEMI (≤ 12 h from symptom onset to first medical contact), mean age 58.05 ±11.3 years; 257 (83.5%) patients were male. The primary endpoint in P-PCI was observed in 16.2% and in Ph-PCI 8.4%; p = 0.038. There was no difference in 30-day total death (5.2% in P-PCI and 3.2% in Ph-PCI), p = 0.39, no difference in heart failure (11% in P-PCI and 5.2% in Ph-PCI), p = 0.06. Secondary endpoint: after PCI sum ST-elevation resolution more than 50%, was seen in 65% in patients in P-PCI group and 76.2% in patients in Ph-PCI group; p = 0.034.
Conclusions:
Ph-PCI was associated with decreased composite endpoints of mortality and heart failure outcomes during 30 days after STEMI and improved ST-segment resolution within 1 h after percutaneous coronary intervention.
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