Efficacy of pharmacoinvasive percutaneous coronary intervention versus primary percutaneous coronary intervention in ST elevation myocardial infarction

Background ST-segment elevation myocardial infarction (STEMI) is mainly caused by complete occlusion of a coronary artery by a thrombus. Primary percutaneous coronary intervention requires transfer to an interventional cardiology center and this delays initiation of reperfusion therapy. A pharmacoinvasive strategy may alleviate the barriers in timely reperfusion of STEMI, especially in a developing country like Egypt.Aim The aim of the study was to assess the safety and efficacy of pharmacoinvasive strategy versus PPCI in STEMI patients at 3 months.Patients and methods A total of 200 patients were presenting with STEMI who were divided into two groups: group 1 included patients who underwent PPCI (n=160) and group 2 included patients who underwent pharmacoinvasive strategy as patients received thrombolytic therapy followed by scheduled coronary angiography and PCI within 24 h from the symptom onset (n=40). Primary end points were death, cardiogenic shock, reinfarction, repeated revascularization of the culprit artery, and congestive heart failure at the time of discharge or at follow-up till 3 months.Results In group 1, we found that about 28.1% of patients had infarct-related artery open and 71.9% were closed, while in group 2 there were 70.0% patients who had infarct-related artery open and 30.0% who had failed thrombolysis. There were 4.4% patients in group 1 and 75.0% patients in group 2 who were with bleeding complication especially at the access site. Complication was less frequent in group 1.Conclusion A pharmacoinvasive strategy resulted in outcomes that were comparable with PPCI at 3 months, suggesting it might be a viable option in Egypt. Larger studies are required to confirm these findings.