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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
In-hospital Outcome of Pharmaco-Invasive (Tenecteplase) versus Primary PCI Strategy in Patients with ST-Elevated
M A Islam1, M L Ali, M S Begum
1Professor Dr Md Azharul Islam, Professor & Head, Department of Cardiology, Rangpur Community Medical College and Hospital, Rangpur, Bangladesh;
Insights
Primary percutaneous coronary intervention (pPCI) is preferred over pharmacoinvasive strategy for ST-elevation myocardial infarction (STEMI) patients presenting early to PCI-capable centers due to lower rates of hypotension and major bleeding.
Area of Science:
- Cardiology
- Interventional Cardiology
- Emergency Medicine
Background:
- ST-elevation myocardial infarction (STEMI) requires timely reperfusion therapy.
- Pharmacoinvasive strategy and primary percutaneous coronary intervention (pPCI) are management options for STEMI.
- Comparing in-hospital outcomes of these strategies is crucial for clinical decision-making.
Purpose of the Study:
- To compare the in-hospital outcomes of pharmacoinvasive strategy versus pPCI in STEMI patients.
- To evaluate efficacy (LVEF, TIMI flow) and safety (mortality, bleeding, stroke, hypotension) of both strategies.
Main Methods:
- Cross-sectional analytical study involving 100 STEMI patients randomized to pPCI (n=50) or pharmacoinvasive strategy (n=50).
- Data collected from January 2020 to June 2022 at Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh.
- In-hospital outcomes including LVEF changes, TIMI flow, mortality, re-infarction, stroke, bleeding, hypotension, cardiogenic shock, and arrhythmia were assessed.
Main Results:
- Both strategies showed significant improvements in LVEF and TIMI flow post-intervention within their respective groups.
- Pharmacoinvasive strategy group had significantly higher incidences of hypotension (42.5% vs 16.0%, p=0.004) and a trend towards higher major bleeding (8.5% vs 2.0%, p=0.162).
- The pharmacoinvasive group alone experienced death (6.0%) and stroke (8.5%).
Conclusions:
- Primary PCI is associated with better in-hospital outcomes, particularly lower rates of hypotension and major bleeding, compared to the pharmacoinvasive strategy in STEMI.
- Pharmacoinvasive strategy is a viable alternative when timely pPCI is not feasible.
- Early presentation to a PCI-capable center favors pPCI for STEMI management.
Abstract:
This cross sectional analytical study was aimed to compare the in-hospital outcome (changes in LVEF, TIMI flow after PCI, major bleeding, acute stroke, mortality, re-infarction, hypotension, cardiogenic shock and arrhythmia) of pharmacoinvasive strategy versus pPCI in STEMI patients. This study was conducted in Ibrahim Cardiac Hospital and Research Institute (ICHRI), Dhaka, Bangladesh from January 2020 to June 2022; to compare the in-hospital outcome of pharmacoinvasive strategy using Tenecteplase with that of pPCI in the management of patients with STEMI. The study included a total of 100 cases of STEMI - randomized to pPCI (n=50) and pharmacoinvasive strategy (n=50). The in-hospital outcome (efficacy and safety) of the two strategies were studied, where efficacy was determined in terms of positive outcome (changes in LVEF and TIMI flow after PCI) and complications (death, re-infarction, acute stroke, hypotension, major episode of bleeding, cardiogenic shock and arrhythmia) experienced by the two groups. The mean age of the pPCI group was 52.9 years and that of pharmacoinvasive group was 56.2 years (p=0.139). Males were predominant in both the study groups; however, males were considerably higher in the pPCI group than that in the pharmacoinvasive group (p=0.054). Although insignificant changes in LVEF and TIMI grade flow (TIMI; p=0.380) between two groups but significant changes of LVEF and TIMI flow were observed in individual group in respect to pre and post PCI (LVEF; pPCI= 0.004 PhI, p=0.005 and TIMI flow; pPCI=0.005, PhI, p=0.004). The distributions of risk factors were almost alike between the two study groups. However, DVD and TVD were significantly higher in pharmacoinvasive group than those in the pPCI group (p=0.010). As outcome was compared between groups, the incidences of death (6.0%) and stroke (8.5%) were observed in pharmacoinvasive group alone. The incidence of hypotension was much higher in the pharmacoinvasive group (42.5%) than that in the pPCI group (16.0%) (p=0.004). Major bleeding episode was much higher in the pharmacoinvasive group (8.5%) than that in the pPCI group (2.0%) (p= 0.162). While pPCI receiving STEMI patients regain nearly full-patency of the culprit vessel. Almost similar result observed in patients received pharmacoinvasive strategy. However; small proportions of patients in pharmacoinvasive strategy cause stroke which may be fatal. Hypotension and major bleeding are also common in pharmacoinvasive strategy than that in pPCI strategy. The pPCI is preferred to pharmacoinvasive strategy if STEMI patients present themselves early in PCI-capable center. However, pharmacoinvasive strategy is a reasonable alternative for patients where pPCI could not be done within the recommended time.
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