13 A CT coronary angiography first strategy in patients determined to have an indication for invasive coronary angiogram: a meta-analysis

Abstract

central death notification and publicly accessible online death notifications. Proximity from home address to the nearest PPCI centre was determined using Google Maps. Statistical analyses were performed using Stata. Results 7,486 STEMI patients were identified from January 2013 -March 2018. 6,612 were included in the analysis. Minimum follow up was 3 years, median follow up was 5.5 years. 4,040 received timely PPCI, 2,162 delayed PPCI, 335 t-PA. Baseline characteristics are shown in table 1. There was no difference in survival between the timely PPCI (84.7%) and t-PA groups (84.2%) (HR 0.93, 95%CI 0.71-1.25; Log-Rank p=0.62). There was increased mortality in the delayed PPCI (80.6%) in comparison with both timely PPCI (HR 1.5, 95%CI 1.16-1.49; Log-Rank p<0.000) and t-PA groups (HR 1.23, 95%CI 0.93-1.66; Log-Rank p=0.16), figure 1, 2. Conclusion Patients who were treated with a pharmaco-invasive strategy had lower all-cause mortality on long term follow up versus those who received PPCI outside of the target treatment window. Given the high proportion of patients who received delayed PPCI (33%), consideration should be given to expanding a pharmaco-invasive approach to patients who are unlikely to receive timely PPCI.