5 Years of FAST-MI: If Unable to Meet the Timeline, Thrombolization Is the Way to Go

A large proportion of patients undergo primary angioplasty beyond the timelines recommended by clinical practice guidelines. These patients have poorer 5-year outcomes compared with those subjected to a pharmaco-invasive strategy.

Claves para mejorar la productividad en la sala de cateterismo

ST-segment elevation myocardial infarction guidelines recommend primary angioplasty as the strategy of choice within 120 min after a diagnostic electrocardiography. If that is not possible, thrombolytic therapy is preferable. However, there is little direct evidence supporting such recommendation.

This work, soon to be published in the European Heart Journal, seeks to analyze the 5-year outcomes of early primary angioplasty vs. primary angioplasty that required a referral to another site vs. a pharmaco-invasive strategy (thrombolytic therapy first, and then referral to a primary angioplasty specialized site).


Read also: Cath Lab Management Protocol for the COVID-19 Outbreak.


Among 4250 patients with ST-segment elevation myocardial infarction between 2005 and 2010, only 2942 consulted a physician within 12 hours after the onset of symptoms. Among the latter, 54% underwent primary angioplasty within 120 min from first medical contact, 28% underwent angioplasty after 120 min, and 28% received fibrinolysis.

Five-year survival was higher with a pharmaco-invasive strategy (89.8%) compared with angioplasty after 120 min (79.5%; hazard ratio [HR]: 1.51). Early thrombolytic therapy was even as good as timely primary angioplasty (mortality: 89.8% vs. 88.2%; HR: 1.02).

Results were still concordant after multiple adjustments.

Conclusion

A significant number of patients undergo primary angioplasty beyond the timelines recommended by clinical practice guidelines. Patients treated beyond 120 min after first medical contact have worse prognosis than those who receive thrombolytic therapy immediately.

oup-accepted-manuscript-2019

Original Title: Five-year outcomes following timely primary percutaneous intervention, late primary percutaneous intervention, or a pharmacoinvasive strategy ST-segment elevation myocardial infarction: the FAST-MI programme. 

Reference: Nicolas Danchin et al. European Heart Journal, article in press.


Subscribe to our weekly newsletter

Get the latest scientific articles on interventional cardiology

We are interested in your opinion. Please, leave your comments, thoughts, questions, etc., below. They will be most welcome.

More articles by this author

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 – ECLIPSE: Randomized Study of Orbital Atherectomy vs Conventional PCI in Severely Calcified Lesions

Coronary calcification is associated with stent under-expansion and increased risk of both early and late adverse events. Atherectomy is an essential tool for uncrossable...

TCT 2024 | Use of Drug-Coated Balloons for Side Branch Treatment in Provisional Stenting

In some cases, treating coronary bifurcations with provisional stenting requires side branch stenting, which may lead to suboptimal outcomes. Drug-coated balloons (DCBs) have emerged...

TCT 2024 | Use of Artificial Intelligence for Patients with Suspected Coronary Artery Disease

The current approach to chest pain mainly focuses on symptom characteristics, conducting functional tests for ischemia assessment. However, several randomized clinical trials have shown...

LEAVE A REPLY

Please enter your comment!
Please enter your name here

Related Articles

SOLACI Sessionsspot_img

Recent Articles

TCT 2024 | FAVOR III EUROPA

The study FAVOR III EUROPA, a randomized trial, included 2,000 patients with chronic coronary syndrome, or stabilized acute coronary syndrome, and intermediate lesions. 1,008...

TCT 2024 | TRISCEND II

This randomized study included 400 patients; 267 were treated with EVOQUE valve and 133 with optimal medical treatment (OMT). After one-year follow-up, there were no...

TCT 2024 – ACCESS-TAVI: Comparing Percutaneous Access Closure Strategies After TAVI

Vascular access complications following transcatheter aortic valve implantation (TAVI) remain common. However, few studies compare vascular access closure methods.  Based on the CHOICE-CLOSURE and MASH...