Very Early Versus Early Percutaneous Coronary Intervention After Successful Fibrinolytic Therapy in Pharmacoinvasive Strategy

BACKGROUND: The proper time for the use of percutaneous coronary intervention (PCI) following the successful fibrinolysis for ST-segment elevation myocardial infarction (STEMI) for maximum efficiency and minimum side effects has not been determined yet. The present study was designed to compare the outcome of myocardial infarction patients who received fibrinolytic therapy with successful results and underwent PCI very early (within 3-12 h) (group 1) versus early (within 12-24 h) (group 2). METHODS: The study compared the occurrence of major adverse cardiac events during PCI (no-reflow phenomenon, access site bleeding, cerebral hemorrhage, and cardiac death). Patients were followed for 6 months after PCI for the occurrence of unstable angina, recurrent angina, non-STEMI, recurrent STEMI, repeat revascularization, heart failure, and cardiac death. RESULTS: Group 1 (121 patients) with the mean age of 59.93 ± 10.43 years were compared with group 2 (144 patients) with the mean age of 62.84 ± 10.22 years. Except for age, the 2 groups were not significantly different regarding baseline characteristics. No-reflow phenomenon was less in group 1 with p value = 0.005, whereas incidence of access site bleeding and cerebral hemorrhage were more in this group with p value = 0.001 and 0.049, respectively. During the period of 6 months' follow-up, recurrent angina and recurrent non-STEMI occurred more in group 2 with p value = 0.049 and 0.035, respectively, with no other significant difference between the 2 groups. CONCLUSIONS: No-reflow phenomenon and the risk of recurrent ischemia is significantly lower in patients undergoing PCI very early after successful fibrinolytic therapy, but the risk of bleeding is increased in this time. So it is recommended that patients received successful fibrinolytic therapy to be subjected to very early PCI within 3 to 12 h from fibrinolysis.