Key result
A pharmaco-invasive strategy showed similar rates of mortality, reinfarction, or stroke compared to primary PCI, but increased major bleeding (approximately 1 in 21 patients).
Why the study?
Does a pharmaco-invasive strategy reduce mortality, reinfarction, or stroke compared to primary PCI in STEMI patients with symptom onset <12 hours?
Does a pharmaco-invasive strategy reduce mortality, reinfarction, or stroke compared to primary PCI in STEMI patients with symptom onset <12 hours?
While a pharmaco-invasive strategy offers similar efficacy to primary PCI for STEMI patients, it is associated with a significantly higher risk of major bleeding.
We read with great interest the recently published article in the October 2016 issue of JACC Cardiovasc Interv by Rashid et al . (1). Briefly, it was a retrospective, single center study that analyzed ST-elevation myocardial infarction (STEMI) patients with symptom onset <12 hours. Patients with primary percutaneous intervention (PCI) were compared with those who received fibrinolytic therapy prior to arrival at the hospital due to non-availability of primary PCI. The authors concluded that the pharmaco-invasive strategy was associated with similar rates of the composite endpoint of mortality, reinfarction, or stroke as compared with a primary PCI strategy. There was propensity for increased bleeding in the pharmaco-invasive group, with a significant fraction (approximately 1 in every 21 patients) having major bleeding, including intracranial bleeding.
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Khalid et al. (2017) conducted a letter in ST-elevation myocardial infarction (STEMI). Pharmaco-invasive strategy (fibrinolytic therapy) vs. Primary percutaneous intervention (PCI) was evaluated on Composite endpoint of mortality, reinfarction, or stroke. A pharmaco-invasive strategy showed similar rates of mortality, reinfarction, or stroke compared to primary PCI, but increased major bleeding (approximately 1 in 21 patients).
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