Key result
Routine early percutaneous coronary intervention performed between 2 and 24 hours after thrombolysis in patients with ST-elevation myocardial infarction improves clinical outcomes compared to standard care.
Why the study?
Does adjunctive PCI performed between 2 and 24 hours after fibrinolysis improve outcomes compared to standard care in STEMI patients?
Does adjunctive PCI performed between 2 and 24 hours after fibrinolysis improve outcomes compared to standard care in STEMI patients?
Routine early PCI (2-24 hours) after successful fibrinolysis in STEMI patients is beneficial and safe, supporting current guideline recommendations.
Adjunctive percutaneous coronary intervention (PCI) performed between 2 and 24 hours after thrombolysis administered to a patient with an ST elevation myocardial infarction (STEMI) appears beneficial and safe. The rationale for routinely following fibrinolysis with PCI is that many patients have a persistent reduction in flow in the infarct-related artery; although fibrinolysis restores patency (TIMI grade 2 or 3) in 80% of infarct-related arteries, normalization of blood flow (TIMI grade 3) is seen in only 50 to 60% of arteries. Adjunctive PCI has been directly compared to a strategy of fibrinolysis and standard care (either PCI for a clinical indication or routine late PCI) in the TRANSFER AMI, GRACIA-1, NORDISTEMI, CARESS-in-AMI, and SIAM III trials, and found to have better outcomes. Based on these results, the 2010 European Society of Cardiology (ESC) guidelines recommend routine urgent PCI after successful fibrinolysis within 24 hours (class I recommendation, level of evidence A).
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Petros Dardas (2012) conducted an editorial in ST elevation myocardial infarction (STEMI). Routine early percutaneous coronary intervention (PCI) vs. Standard care (ischemia-guided management or delayed PCI) was evaluated on Composite of death, reinfarction, heart failure, severe recurrent ischemia or shock at 30 days (TRANSFER AMI trial) (OR 0.64, 95% CI 0.47-0.87). Routine early percutaneous coronary intervention performed between 2 and 24 hours after thrombolysis in patients with ST-elevation myocardial infarction improves clinical outcomes compared to standard care.
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