Late outcomes of ST-elevation myocardial infarction treated by pharmaco-invasive or primary percutaneous coronary intervention. (2nd December 2022)

• Record Type: Journal Article
• Authors: Jamal, Javeria; Idris, Hanan; Faour, Amir; Yang, Wesley; McLean, Alison; Burgess, Sonya; Shugman, Ibrahim; Wales, Kathryn; O'Loughlin, Aiden; Leung, Dominic; Mussap, Christian Julian; Juergens, Craig Phillip; Lo, Sidney; French, John Kerswell
• Is Part Of: European heart journal. Volume 44:Number 6(2023)
• Page Start: 516
• Page End: 528
• Publication Date: 2022-12-02
• Subjects: Timely primary PCI -- Pharmaco-invasive strategy; Cardiology -- Periodicals; Heart -- Diseases -- Periodicals; 616.12005
• DOI: 10.1093/eurheartj/ehac661
• Languages: English
• ISSNs: 0195-668X

Abstract

Abstract: Aims: Pharmaco-invasive percutaneous coronary intervention (PI-PCI) is recommended for patients with ST-elevation myocardial infarction (STEMI)who are unable to undergo timely primary PCI (pPCI). The present study examined late outcomes after PI-PCI (successful reperfusion followed by scheduled PCI or failed reperfusion and rescue PCI)compared with timely and late pPCI (>120 min from first medical contact). Methods and results: All patients with STEMI presenting within 12 h of symptom onset, who underwent PCI during their initial hospitalization at Liverpool Hospital (Sydney), from October 2003 to March 2014, were included. Amongst 2091 STEMI patients (80% male), 1077 (52%)underwent pPCI (68% timely, 32% late), and 1014 (48%)received PI-PCI (33% rescue, 67% scheduled). Mortality at 3 years was 11.1% after pPCI (6.7% timely, 20.2% late) and 6.2% after PI-PCI (9.4% rescue, 4.8% scheduled); P < 0.01. After propensity matching, the adjusted mortality hazard ratio (HR) for timely pPCI compared with scheduled PCI was 0.9 (95% CIs 0.4–2.0) and compared with rescue PCI was 0.5 (95% CIs 0.2–0.9). The adjusted mortality HR for late pPCI, compared with scheduled PCI was 2.2 (95% CIs 1.2–3.1)and compared with rescue PCI, it was 1.5 (95% CIs 0.7–2.0). Conclusion: Patients who underwent late pPCI had higher mortality rates than those undergoing a pharmaco-invasive strategy. Despite rescue PCI being required in a third of patients, a pharmaco-invasive approach should be considered when delays to PCI are anticipated, as it achieves better outcomes than late pPCI. Structured Graphical Abstract: Structured Graphical Abstract A propensity-matched comparison of late outcomes amongst patients who underwent timely primary PCI, late primary PCI, or a pharmaco-invasive strategy; STEMI, ST-Elevation Myocardial Infaction; PCI, percutaneous coronary intervention; pPCI, primary percutaneous coronary intervention.