Key result
In a real-world registry of a decade-long STEMI network based on a pharmacoinvasive strategy, the overall in-hospital mortality rate was 5.6% despite prolonged time metrics for reperfusion.
Why the study?
Pharmacoinvasive strategy is effective when primary PCI cannot be performed timely, prompting evaluation of care metrics and cardiovascular outcomes in a decade-long network.
Observational (n=2,710)
Yes
A decade-long registry of a pharmacoinvasive strategy for STEMI in Brazil demonstrated low rates of in-hospital mortality and cardiovascular outcomes despite prolonged time metrics.
Low mortality and events observed in real-world pharmacoinvasive STEMI network despite delays; supports feasibility but leaves open randomized confirmation.
Background: Pharmacoinvasive strategy is an effective myocardial reperfusion therapy when primary percutaneous coronary intervention (p-PCI) cannot be performed in a timely manner. Methods: Authors sought to evaluate metrics of care and cardiovascular outcomes in a decade-long registry of a pharmacoinvasive strategy network for the treatment of ST-elevation myocardial infarction (STEMI). Data from a local network including patients undergoing fibrinolysis in county hospitals and systematically transferred to the tertiary center were accessed from March 2010 to September 2020. Numerical variables were described as median and interquartile range. Area under the curve (AUC-ROC) was used to analyze the predictive value of TIMI and GRACE scores for in-hospital mortality. Results: A total of 2,710 consecutive STEMI patients aged 59 [51-66] years, 815 women (30.1%) and 837 diabetics (30.9%) were analyzed. The time from symptom onset to first-medical-contact was 120 [60-210] minutes and the door-to-needle time was 70 [43-115] minutes. Rescue-PCI was required in 929 patients (34.3%), in whom the fibrinolytic-catheterization time was 7.2 [4.9-11.8] hours, compared to 15.7 [6.8-22,7] hours in those who had successful lytic reperfusion. All cause in-hospital mortality occurred in 151 (5.6%) patients, reinfarction in 47 (1.7%) and ischemic stroke in 33 (1.2%). Major bleeding occurred in 73 (2.7%) patients, including 19 (0.7%) cases of intracranial bleeding. C-statistic confirmed that both scores had high predictive values for in-hospital mortality, demonstrated by TIMI AUC-ROC of 0.80 [0,77-0.84] and GRACE AUC-ROC of 0.86 [0.83 - 0.89]. Conclusion: In a real world registry of a decade-long network for the treatment of ST-elevation myocardial infarction based on the pharmacoinvasive strategy, low rates of in-hospital mortality and cardiovascular outcomes were observed, despite prolonged time metrics for both fibrinolytic therapy and rescue-PCI. Register Clinicaltrials.gov NCT02090712 date of first registration 18/03/2014.
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Moraes et al. (2023) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=2,710). Pharmacoinvasive strategy was evaluated on In-hospital mortality. In a real-world registry of a decade-long STEMI network based on a pharmacoinvasive strategy, the overall in-hospital mortality rate was 5.6% despite prolonged time metrics for reperfusion.
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