The Strategic Reperfusion Early After Myocardial Infarction trial and the French Registry of Acute Myocardial Infarction 2015 suggest that pharmacoinvasive strategy compares favorably with primary percutaneous coronary intervention (PCI).
This study compared the impact of pharmacoinvasive strategy with the impact of primary angioplasty in real-world patients admitted with acute coronary syndrome with ST-segment elevation.
The study used the Korea Acute Myocardial Infarction Registry to identify patients with ST-segment elevation receiving either pharmacoinvasive strategy defined as thrombolysis followed by coronary angioplasty (whether it be rescue, urgent or routine elective; n = 708) or primary angioplasty (n = 8878). Patients receiving angioplasty within 3 hours from thrombolysis (facilitated angioplasty) were excluded.
Outcomes at 12 months were analyzed after propensity score matching, with 706 patients in each cohort.
The pharmacoinvasive group had shorter time to reperfusion therapy (165 vs. 241 minutes; p <0.001) and a higher rate of pre-procedure TIMI (Thrombolysis in Myocardial Infarction) flow 3 (50.4% vs. 13.7%; p <0.001).
Incidences of major bleeding and stroke were similar in both cohorts.
At twelve months, rates of death and major cardiac events (a composite of death, infarction, target-vessel revascularization, and myocardial revascularization surgery) were similar between pharmacoinvasive strategy and primary angioplasty groups (4.4% vs. 4.1% and 7.5% vs. 7.8%, respectively).
The benefits of pharmacoinvasive strategy are similar to those derived from primary angioplasty when this procedure is delayed for over 100 minutes.
Conclusion
Patients undergoing ST-segment-elevation infarction receiving pharmacoinvasive strategy have shorter time to reperfusion and a higher TIMI flow 3 than patients undergoing primary angioplasty. At 12 months, the rate of combined events was similar in both strategies.
Original title: Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in Patients with ST-Segment–Elevation Myocardial Infarction. A Propensity Score–Matched Analysis.
Reference: Sim DS et al. Circ Cardiovasc Interv. 2016 Sep;9(9).
We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.
