In-hospital course and short term outcomes of early Pharmacoinvasive strategy versus delayed percutaneous coronary intervention for ST-elevation myocardial infarction

Abstract

Timely primary percutaneous coronary intervention remains the reperfusion strategy of choice in patients with acute ST-segment elevation myocardial infarction (STEMI) to achieve prompt and permanent restoration of epicardial blood flow and tissue level perfusion and improves event-free survival, however this requires immediate transfer to an experienced interventional center which often poses logistical problems and a loss of time. Pharmacoinvasive strategy (coronary intervention immediately after thrombolysis) may successfully alleviate the logistic or geographical barriers of primary PCI and could be an attractive option to cover this gap and improve the limited patency rates particularly in a developing country. The aim of our study was to assess angiographic effectiveness of percutaneous coronary intervention performed after thrombolytic therapy by TIMI flow grade and myocardial blush grade post-PCI, early (3-24 hrs) or late (within one week) in patients with high risk STEMI and incidence of major adverse cardiovascular events (MACEs) in the two groups. 100 patients with acute STEMI divided into two groups, (50 patient each) were included in this study  Group A: Pharmacoinvasive treatment (strategy of immediate transfer for PCI within 3-24 hours from thrombolytic therapy administration regardless of the presence or absence of its successfulness).  Group B: Deferred PCI strategy (intervention performed within one week after thrombolytic therapy). In-hospital and short term follow up (30 days) for major adverse cardiovascular events including death, recurrent ischemic events, development of new or worsening heart failure requiring hospitalization, ischemic stroke, target vessel revascularization and cardiogenic shock. The results of our study showed greater incidence of major adverse cardiovascular events (MACEs) in deferred PCI group compared pharmacoinvasive group (84% vs 46%) in those particular patients with high risk GRACE score (GRACE risk score ≥155). The overall mortality rate was higher in group B (18%) compared with group A (6%). Both in hospital and 30 days mortality were higher in the group B (10% and 8% respectively). The results of our study showed significant greater incidence of heart failure and cardiogenic shock during hospital admission in group B compared with group A (50% vs. 20%; P value = 0.002) (20% vs. 4%; P value = 0.014) respectively. The results of our study also showed significant greater incidence of acute coronary syndrome (58% vs. 26%; P value = 0.010), heart failure (26% vs. 8%; P value = 0.017) and cardiogenic shock (20% vs. 4%; P value = 0.014) at 30 days follow up in group B compared with group A.