Primary PCI versus Early Routine Post Fibrinolysis PCI for ST Elevation Myocardial Infarction
Ayman Mohamed Ahmed Fkirin Helal;
Abstract
Background- Pharmaco-invasive strategy performed between 3 and 24 hours appears beneficial and safe. The rationale for following fibrinolysis with PCI is that many patients have a persistent reduction in flow in the infarct-related artery. The aim of the present study is to assess the effect of immediate fibrinolysis (with streptokinase “The widely available fibrinolytic in Egypt”) in patients presented with acute STEMI followed by transferal and PCI within 3-
24 hours compared to primary PCI and ischemia driven PCI on infarction size and microvascular obstruction.
Methods and Results- Sixty patients with first attack of acute STEMI within
12h were enrolled in this randomized multi-centers case-control study. The patients were randomized to 4 groups (15 patients each): primary PCI for patients presented to PPCI-capable centers (group I), transfer to PCI if presented to non-PCI capable center (group II), pharmaco-invasive strategy (group III) and fibrinolytic (streptokinase) and ischemia driven PCI (group IV). The primary endpoint is the infarct size assessed by cardiac MRI 3-5 days post MI. Death, reinfarction or disabling stroke were constitute the clinical (secondary) endpoints. The key safety (secondary) endpoint was be the incidence of major bleeding. The estimated patient delay was 6.1+2.5 hours with non-significant differences in the 4 groups. The system delay was 57+56, min in group I,
175.7+29 min in group II, 40.7+8.6 min in group III and IV. There was significantly larger infarction size in group IV compared to group I (49770+68449 vs. 28391+30322 mm3, P=0.03), group II (49770+68449 vs.
28553+20006 mm3, P=0.03) and group III (49770+68449 vs. 27580+20945 mm3, P=0.02). But minor bleeding was significantly higher in group III compared to other groups due to puncture site related bleeding (33% of patients in group III vs. 13% in group IV vs. 0% in group I and II, P=0.006). Conclusions- Compared to fibrinolysis followed by ischemia guided intervention, pharmaco-invasive strategy using streptokinase with PCI within 3-
24 hours resulted in effective reperfusion and smaller infarction size in patients
with acute STEMI. However, pharmaco-invasive strategy was associated with a slightly increased risk of minor bleeding.
Key words: pharmaco-invasive strategy, primary PCI, myocardial infarction, infarction size, cardiac MRI.
24 hours compared to primary PCI and ischemia driven PCI on infarction size and microvascular obstruction.
Methods and Results- Sixty patients with first attack of acute STEMI within
12h were enrolled in this randomized multi-centers case-control study. The patients were randomized to 4 groups (15 patients each): primary PCI for patients presented to PPCI-capable centers (group I), transfer to PCI if presented to non-PCI capable center (group II), pharmaco-invasive strategy (group III) and fibrinolytic (streptokinase) and ischemia driven PCI (group IV). The primary endpoint is the infarct size assessed by cardiac MRI 3-5 days post MI. Death, reinfarction or disabling stroke were constitute the clinical (secondary) endpoints. The key safety (secondary) endpoint was be the incidence of major bleeding. The estimated patient delay was 6.1+2.5 hours with non-significant differences in the 4 groups. The system delay was 57+56, min in group I,
175.7+29 min in group II, 40.7+8.6 min in group III and IV. There was significantly larger infarction size in group IV compared to group I (49770+68449 vs. 28391+30322 mm3, P=0.03), group II (49770+68449 vs.
28553+20006 mm3, P=0.03) and group III (49770+68449 vs. 27580+20945 mm3, P=0.02). But minor bleeding was significantly higher in group III compared to other groups due to puncture site related bleeding (33% of patients in group III vs. 13% in group IV vs. 0% in group I and II, P=0.006). Conclusions- Compared to fibrinolysis followed by ischemia guided intervention, pharmaco-invasive strategy using streptokinase with PCI within 3-
24 hours resulted in effective reperfusion and smaller infarction size in patients
with acute STEMI. However, pharmaco-invasive strategy was associated with a slightly increased risk of minor bleeding.
Key words: pharmaco-invasive strategy, primary PCI, myocardial infarction, infarction size, cardiac MRI.
Other data
| Title | Primary PCI versus Early Routine Post Fibrinolysis PCI for ST Elevation Myocardial Infarction | Other Titles | بار الشريان التاجى بالقسطره الاوليه مقارنه بالربا المبكر الروتينى للشريان التاجى بعد مذيبات التخثر فى مرضى الاحتشاء القلبى | Authors | Ayman Mohamed Ahmed Fkirin Helal | Issue Date | 2016 |
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