Comparison of Primary Percutaneous Coronary Intervention (PPCI) vs. Pharmacoinvasive strategy as Reperfusion Strategies in patients with ST-elevation myocardial infarction (STEMI)

Background – Guidelines recommended primary percutaneous coronary intervention (PPCI) as the preferred reperfusion strategy in the treatment of patients with ST-elevation myocardial infarction (STEMI). However, PPCI might not be readily available in the real-world situations due to the limitation of resources. A pharmacoinvasive strategy consisting of early thrombolytic therapy followed by PCI was suggested as an alternative reperfusion approach. Prior studies had shown that clinical outcomes of pharmacoinvasive strategy were comparable to PPCI. The purpose of this retrospective study was to assess the outcomes of reperfusion strategies in patients with STEMI in the North Territories East of Hong Kong, comparing a pharmacoinvasive strategy with PPCI. Methods – This cohort study included 258 patients with STEMI in the New Territories East of Hong Kong from October 2020 to December 2021, with a 1-year follow-up. A composite outcome was measured based on death, recurrent myocardial infarction, heart failure requiring hospitalization, target-vessel revascularization, and coronary artery bypass graft surgery at 30 days and 1 year follow-up. The incidence of stroke and major bleeding during hospitalization were measured as the safety end points. Results – There was no significant difference in the incidence of primary outcome between pharmacoinvasive strategy and PPCI at 1 year follow-up, in both univariate analysis (RR = 0.78; 95% CI 0.25 – 2.47; P = 1.00), and multivariable analysis (OR = 0.59; 95% CI 0.16 – 2.23; P = 0.440). Conclusion – Pharmacoinvasive strategy had demonstrated a comparable 1-year clinical outcome to PPCI in patients with STEMI.