Why the study?
Not all patients with STEMI in Saudi Arabia are managed with primary percutaneous coronary intervention, prompting an analysis of real-world management strategies.
Does primary percutaneous coronary intervention (PPCI) improve mortality and reduce recurrent ischemic events compared to thrombolytic therapy or conservative management in patients with STEMI?
Observational (n=1,471)
Yes
Does primary percutaneous coronary intervention (PPCI) improve mortality and reduce recurrent ischemic events compared to thrombolytic therapy or conservative management in patients with STEMI?
Absolute Event Rate: 11% vs 12%
In a Saudi Arabian registry of STEMI patients, PPCI was underutilized but significantly reduced recurrent ischemic events compared to thrombolysis or conservative management, though 1-year mortality differences were not statistically significant.
Background and objective Not all patients with ST-elevation myocardial infarction (STEMI) in Saudi Arabia are managed with a primary percutaneous coronary intervention (PPCI). We analyzed the management strategies for STEMI patients in the Saudi Acute Myocardial Infarction Registry (STARS). The strategies include PPCI, revascularization with thrombolytic therapy, and conservative management. This study involved a sub-study of the STARS. Methods STEMI patients were categorized into three groups. Group 1 was managed with PPCI, group 2 with revascularization with thrombolytic therapy, and group 3 with conservative approaches. The data were collected at presentation, at one month, and at one year after discharge. Results The sample consisted of 1,471 patients. The mean age of the participants was 54 ±12 years; 51% were Saudi citizens, and the majority (89%) were male. Their background revealed a high coronary risk profile, with 48% diagnosed with diabetes mellitus (DM) and 44% with hypertension (HTN); 54% were active or ex-smokers, 30% had a high lipid profile, and 74% were overweight. PPCI was performed in 42%, and 29% were managed with revascularization using thrombolytic therapy. A conservative approach was followed in 29% of the patients. Patients who had a stroke were treated conservatively due to the risk of bleeding. The patients in group 1 were mostly hypertensive with recurrent angina and a history of prior revascularization, with PPCI or coronary artery bypass grafting (CABG). The crude all-cause mortality at one year was 11%; it was 7% at one month for group 1, 8% for group 2, and 9% for group 3, which was not statistically significant. Conclusions Controlling the risk factors and improving access to PPCI in hospitals are fundamental in the management of STEMI patients. PPCI is still underused. Guideline-directed medical therapy (GDMT) is a reasonable approach if PPCI is not available.
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Kinsara et al. (2020) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=1,471). Primary percutaneous coronary intervention (PPCI) vs. Thrombolytic therapy or conservative management was evaluated on All-cause mortality at 1 year.
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