Pharmacoinvasive Strategy vs Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Study in Mexico City

Abstract

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Outcomes in ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention or pharmacoinvasive strategy in a Latin American country

“…ST-segment elevation myocardial infarction (STEMI) requires timely reperfusion therapy which may be carried out by two treatment strategies: primary percutaneous coronary intervention (PPCI) [ 1 ] or a pharmacoinvasive strategy (PIs). A lower mortality rate has been reported in patients who receive PPCI in clinical trials conducted in high-volume centers and with adequate ischemic times [ 2 ].…”

Respuesta a la carta al editor: “Estrategia farmacoinvasiva: herramienta para evitar la Paradoja de Reperfusión en redes de infarto”

“…Regarding the questions raised by the authors, successful reperfusion after fibrinolytic was achieved in 59.1%; however, the number of patients with contraindications to fibrinolysis was not recorded. Nevertheless, our complication rate was low 2 . We agree that door-to-needle time was higher than other similar studies, although we did not find significant differences in clinical outcomes.…”

Reperfusion Strategy of ST-Elevation Myocardial Infarction: A Meta-Analysis of Primary Percutaneous Coronary Intervention and Pharmaco-Invasive Therapy

“…Among the RCTs, the WEST (Which Early ST-elevation myocardial infarction Therapy) study compared three strategies, such as thrombolysis with tenecteplase, tenecteplase with invasive treatment within 24 h, and pPCI ( 10 ); the GRACIA-2 (Grupo de Ana’lisis de la Cardiopatı ‘a Isque’mica Aguda) study compared full-dose tenecteplase followed by stenting within 3–12 h and pPCI within 3 h of randomization ( 11 ); the EARLY–MYO trial compared PIT strategy with half-dose alteplase and PCI within 3–24 h versus pPCI ( 12 ); two articles came from Strategic Reperfusion Early After Myocardial Infarction (STREAM) study with different follow-up time, comparing PIT strategy with tenecteplase followed by coronary angiography within 6–24 h and pPCI ( 6 , 13 ). Among the observational studies, the STEPP–AMI study compared PIT strategy with tenecteplase and PCI within 3–24 h versus pPCI ( 14 ); the FAST–MI study compared pPCI with PIT, where 78% of patients used tenecteplase and 84% of patients underwent PCI during hospital stay ( 15 ); an analysis from the Vital Heart Response (VHR) Program compared pPCI strategy and PIT strategy with tenecteplase, but the median time from successful fibrinolysis to scheduled invasive treatment was 23.4 h ( 16 ); the PHASE-MX (Evaluation of Pharmacoinvasive Strategy versus percutaneous coronary intervention in patients with acute myocardial infarction with ST-segment Elevation at the National Institute of Cardiology in Mexico City) study, REPERFUSE Kuwait (reperfusion in ST-elevation myocardial infarction in Kuwait) and another two studies from India and Canada compared PIT with invasive treatment operated within the first 24 h after hospital admission and pPCI in a real-world setting ( 17 – 20 ); Chava et al compared PIT and pPCI in bleeding complications ( 21 ); Bodi et al compared PIT and pPCI in efficacy through cardiac magnetic resonance change in the first week and sixth month ( 22 ); Vincent Auffret compared PIT and pPCI in older patients (age >70 years old) ( 23 ); Doo Sun Sim et al operated a propensity score–matched analysis to evaluate 12-month clinical outcome of STEMI patients undergoing PIT and pPCI from KAMIR (Korea Acute Myocardial Infarction Registry) ( 24 ); another study published in last year compared outcomes of timely pPCI (≤120 min), delayed pPCI (121–180 min), late pPCI (>180 min) with PIT strategies ( 25 ).…”