Late outcomes of ST-elevation myocardial infarction treated by pharmaco-invasive or primary percutaneous coronary intervention

Jamal, Javeria; Idris, Hanan; Faour, A.; Yang, Wesley; McLean, Alison; Burgess, Sonya; Shugman, I.; Wales, K.; O'Loughlin, Aiden; Leung, Dominic Y.; Mussap, C.; Juergens, C.; Lo, S.; French, John K.

doi:10.1093/eurheartj/ehac661

Cited by 11 publications

(5 citation statements)

References 39 publications

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“…29 Jamal et al found that patients who underwent late PPCI had higher mortality rates than those underwent a PI strategy. 30 In our study, compared with timely PPCI and late PPCI, scheduled PCI group was better in in-hospital mortality and MACCEs, which indicated early thrombolytic therapy may further shorten the myocardial ischemia time and reduce the ischemic events. The rate of heart failure was higher in the scheduled PCI, which may be caused by the worse condition of the scheduled PCI group, especially in the ratio of Killip II-IV class.…”

Section: Discussionmentioning

confidence: 49%

Reperfusion strategies in patients with ST-segment elevation myocardial infarction during hospitalization in China: Findings from the Improving Care for Cardiovascular disease in China (CCC)-Acute Cronary Synrome project

Wang,

Zhang,

et al. 2023

Preprint

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ObjectiveTo analyze the current situation of reperfusion strategies of ST-segment elevation myocardial infarction (STEMI) in China and evaluate the efficacy and safety of different reperfusion strategies, especially pharmaco-invasive percutaneous coronary intervention (PI-PCI).MethodsThe CCC-ACS (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) project is a joint study between the American Heart Association and Chinese Society of Cardiology (CSC). STEMI patients who were recruited to the CCC-ACS project between November 2014 and December 2019 and admitted within 48 hours after symptom onset and treated by thrombolysis or percutaneous coronary intervention (PCI) were included in this cohort study. The primary efficacy outcomes were major adverse cardiac cerebrovascular events (MACCEs) that occurred during hospitalization. The primary safety outcomes were Thrombolysis in Myocardial Infarction (TIMI) major or minor bleedings criteria during hospitalization. Univariate regression logistic analysis, multivariable logistic regression analysis, propensity score-matched analysis, and inverse probability of treatment weighting analysis were performed to evaluate the efficacy and safety of different reperfusion strategies.ResultsOf 37733 STEMI patients, 35019 patients received primary percutaneous coronary intervention (PPCI), 999 patients received thrombolysis and 1715 patients received PI-PCI. Compared with PPCI, the thrombolysis group had higher incidence of all cause death (1.6% vs 2.8%, P =0.003), MACCEs (2.0% vs 3.6%, P < 0.001), and TIMI major bleedings (1.2% vs 2.2%, P=0.007). In the PI-PCI group, the incidence of MACCEs (2.0% vs 0.8%, P =0.001), all cause death (1.6% vs 0.4%, P =0.001), and cardiac death (1.5% vs 0.4%, P =0.001) were significantly lower than PPCI group; and the same conclusion was found in the subgroup of in time from first medical contact(FMC) to reperfusion ≥ 3h. However, the risk of TIMI minor bleedings (5.1% vs 6.7%, P=0.008) was higher in the PI-PCI group in the subgroup of in time from FMC to reperfusion ≥ 3h. Compared with timely PPCI group, the incidence of all cause death was significantly lower and the incidence of heart failure was higher in the scheduled PCI group. Compared with late PPCI group, the incidence of all cause death, MACCEs were significantly lower in scheduled PCI group. Compared with timely PPCI, the ratio of heart failure was statistically significant higher in the rescue PCI group. There was no significant difference in all outcomes in all models between rescue PCI group and late PPCI group. Moreover, compared with scheduled PCI ≤ 24h group, the scheduled PCI during 24h to 7d group had lower risk of TIMI major or minor bleedings and the scheduled PCI >7d group had the similar risk of bleedings; the scheduled PCI >7d group had lower risk of heart failure.ConclusionsThis study demonstrates that in STEMI patients who could not perform timely PPCI, PI-PCI is feasible, including rescue PCI,which can reduce the rate of MACCEs and mortality during hospitalization.But the increased risk of bleedings also should be noted.In scheduled PCI after successful thrombolysis, appropriate extension the time window of scheduled PCI can be considered under stable clinical conditions.

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Section: Discussionmentioning

confidence: 49%

Reperfusion strategies in patients with ST-segment elevation myocardial infarction during hospitalization in China: Findings from the Improving Care for Cardiovascular disease in China (CCC)-Acute Cronary Synrome project

Wang,

Zhang,

et al. 2023

Preprint

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“…7 In the study by Javeria et al, which included 2091 patients with STEMI within 12 h of symptom onset who underwent PCI during hospitalization at Liverpool Hospital (Sydney), the mortality rate during follow-up was higher in patients who underwent late PCI compared with those who underwent a PI-strategy; however, the rates of re-infarction, ischemic stroke, intracranial hemorrhage and major hemorrhage were similar between the two reperfusion strategies. 8 Doo Sun Sim and his team used the Korean acute myocardial infarction registry to compare two groups of patients who received either a PI-strategy defined as fibrinolysis followed by PCI (n = 708) versus the late PCI (n = 8878). In this study, patients who received a PI-strategy benefited from a shorter reperfusion time and a greater permeability of the culprit vessel compared with patients who had late PCI, but with a similar clinical outcome at 12 months.…”

Section: Discussionmentioning

confidence: 99%

“…In the study by Javeria et al, which included 2091 patients with STEMI within 12 h of symptom onset who underwent PCI during hospitalization at Liverpool Hospital (Sydney), the mortality rate during follow-up was higher in patients who underwent late PCI compared with those who underwent a PI-strategy; however, the rates of re-infarction, ischemic stroke, intracranial hemorrhage and major hemorrhage were similar between the two reperfusion strategies. 8 …”

Section: Discussionmentioning

confidence: 99%

Pharmaco-invasive Therapy: A Continued Role for Fibrinolysis in the Primary PCI era

Bouyaddid,

Bouchlarhem,

Bazid

et al. 2023

Clin Appl Thromb Hemost

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Introduction Early Primary percutaneous coronary intervention (pPCI) is the preferred reperfusion therapy for most patients with ST-segment elevation myocardial infarction (STEMI), and the European guidelines recommend pPCI to occur within 120 min of first medical contact. However, this is not always available. Methods We performed a retrospective study of patients admitted for STEMI to a level I cardiac intensive care unit in a developing country, to analyze the efficacy of the pharmaco-invasive (PI) strategy versus late PCI over a 2-year follow-up. Results Four hundred and thirty-nine STEMI patients presented within the first 12 h of symptom onset, pPCI was performed in 154 patients, PI-strategy in 185 patients, and finally Late PCI in 100 patients. All-cause mortality at 2-year risk was statistically significant associated with cardiogenic shock during initial hospitalization, LM and ostio-proximal left anterior descending artery as the culprit artery, severe conductance disorders requiring the use of a temporary pacemaker, and acute kidney disease with glomerular filtration rate < 30 ml/min/1.72 m2 . For the revascularization strategy, there as a well-demonstrated benefit of the pPCI versus Late PCI strategy with (hazard ratio (HR) = 0.293; 95% confidence interval (CI) 0.11–0.737; P = 0.009), as well as a benefit of the PI-strategy versus Late PCI strategy with (HR = 0.433; 95%CI 0.21–0.87; P = 0.02). However, there was no difference between the pPCI and PI-strategy. Conclusion The PI-strategy remains a reasonable alternative for pPCI when the latter is not available, with a prognosis almost identical to pPCI in the long term whenever patients are treated early after the onset of symptoms.

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“…Таким образом, у пациентов, которым было проведено позднее пЧКВ, смертность оказалась выше, чем у пациентов, перенесших фармакоинвазивное лечение. Несмотря на то, что трети пациентов, получивших ТЛТ, требуется спасительное ЧКВ, при ожидаемой задержке пЧКВ предпочтителен фармакоинвазивный подход, так как он обеспечивает лучшие исходы, чем позднее пЧКВ [20].…”

Section: актуальность фармакоинвазивной стратегии в лечении импStunclassified

Features of the Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction According to the Russian Registry of Acute Myocardial Infarction – REGION-IM

Boytsov,

Shakhnovich,

Tereschenko

et al. 2024

Kardiologiia

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Aim. Based on data from the Russian REGION-IM registry, to study the features of reperfusion therapy in patients with ST-segment elevation myocardial infarction (STEMI) in real-life clinical practice.Material and methods. REGION-IM is a multicenter prospective observational study. The observational period is divided into 3 stages: during the stay in the hospital and at 6 and 12 months after inclusion in the registry. The patient's records contain demographic and history data; information about the present case of MI, including the time of the first symptom onset, first contact with medical personnel, and admission to the hospital; coronary angiography (CAG) data, percutaneous coronary intervention (PCI) data, and information about the thrombolytic therapy (TLT).Results. Reperfusion therapy was performed in 88.9 % of patients with STEMI. Primary PCI (pPCI) was performed in 60.6 % of patients. The median time from the onset of symptoms to pPCI was 315 minutes [195; 720]. The median time from ECG to pPCI was 110 minutes [84;150]. Isolated TLT was performed in 7.4 %, pharmaco-invasive treatment tactics were used only in 20.9 % of cases. The median time from ECG to TLT (prehospital and in-hospital) was 30 minutes [10; 59], whereas the median time from ECG to prehospital TLT was 18 minutes [10; 39], and in 63 % of patients, TLT was performed more than 10 minutes after diagnosis. PCI followed TLT in 73 % of patients.Conclusion. The frequency of reperfusion therapy for STEMI in the Russian Federation has increased considerably in recent years. The high frequency of pPCI is noteworthy, but the timing of pPCI does not always comply with clinical guidelines. The results of this registry confirm the high demand for pharmaco-invasive strategies in real-life clinical practice. Taking into account geographical and logistical features, implementing timely myocardial reperfusion requires prehospital TLT. However, the TLT frequency in the Russian Federation is still insufficient despite its proven maximum effectiveness in the shortest possible time from the detection of acute MI.

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Late outcomes of ST-elevation myocardial infarction treated by pharmaco-invasive or primary percutaneous coronary intervention

Cited by 11 publications

References 39 publications

Reperfusion strategies in patients with ST-segment elevation myocardial infarction during hospitalization in China: Findings from the Improving Care for Cardiovascular disease in China (CCC)-Acute Cronary Synrome project

Reperfusion strategies in patients with ST-segment elevation myocardial infarction during hospitalization in China: Findings from the Improving Care for Cardiovascular disease in China (CCC)-Acute Cronary Synrome project

Pharmaco-invasive Therapy: A Continued Role for Fibrinolysis in the Primary PCI era

Features of the Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction According to the Russian Registry of Acute Myocardial Infarction – REGION-IM

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