Key result
Fibrinolysis with deferred PCI achieves ~38-minute faster reperfusion than primary PCI with comparable outcomes.
Why the study?
The efficacy of fibrinolysis therapy with deferred percutaneous coronary angioplasty versus primary angioplasty during the COVID-19 pandemic is unclear when medical quarantine is needed.
Does fibrinolysis therapy combined with deferred PCI reduce ischemia time and improve in-hospital adverse clinical outcomes compared to primary angioplasty in STEMI patients during the COVID-19 pandemic?
Observational (n=143)
No
Does fibrinolysis therapy combined with deferred PCI reduce ischemia time and improve in-hospital adverse clinical outcomes compared to primary angioplasty in STEMI patients during the COVID-19 pandemic?
Fibrinolysis combined with deferred PCI reduces ischemia time with similar in-hospital adverse outcomes compared to primary PCI for STEMI patients during pandemic conditions requiring medical quarantine.
Answers are grounded in this paper and cite their sources.
May support fibrinolysis with deferred PCI to shorten STEMI delays under quarantine; hypothesis-generating and requires randomized confirmation.
Introduction The efficacy of fibrinolysis therapy with deferred percutaneous coronary angioplasty (FPCI) versus primary angioplasty (PPCI) during the coronavirus disease 2019 (COVID-19) pandemic is unclear when medical quarantine is needed. Patients and Methods Acute ST segment elevation myocardial infarction (STEMI) patients underwent PPCI after finishing the screening protocol from January 23, 2020 to June 10, 2020 while FPCI was applied when COVID-19-confirmed cases reoccurred in Beijing near our hospital from June 11, 2020 to July 20, 2020. The door-to-balloon time (DTB) or door-to-needle time (DTN) as well as in-hospital adverse clinical outcomes were compared between the two groups. A propensity score-matched (PSM) analysis was performed to diminish the potential influence of confounding factors on the clinical outcomes. Results A total of 126 STEMI patients underwent PPCI after finishing the screening protocol and 17 patients received FPCI before PSM. Patients who received FPCI were younger than patients who underwent PPCI (50.8±14.0 versus 64.1±14.2 years, p=0.001), and chronic kidney disease (CKD) was less common in FPCI patients than in patients who underwent PPCI (0% versus 24.6%, p=0.024). The DTN was significantly shorter than DTB (25.8±4.2 versus 61.1±10.7, p=0.000) before PSM. The DTN was significantly shorter than DTB (26.9±4.2 versus 64.9±23.6, p=0.000); however, the incidence rate of in-hospital ischemia and bleeding adverse clinical outcomes were comparable between the two groups after PSM. Conclusion Fibrinolysis therapy combined with deferred PCI can reduce the ischemia time and has a similar in-hospital adverse clinical outcome rate compared with patients who underwent primary PCI during the COVID-19 pandemic.
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Nan et al. (2021) conducted an observational in Acute ST segment elevation myocardial infarction (STEMI) (n=143). Fibrinolysis therapy combined with deferred PCI vs. Primary angioplasty (PPCI) was evaluated on Door-to-needle time (DTN) or door-to-balloon time (DTB) and in-hospital adverse clinical outcomes (p=0.000). Fibrinolysis therapy with deferred PCI yielded significantly shorter treatment times than primary PCI (26.9 vs 64.9 minutes, p=0.000), with comparable in-hospital adverse clinical outcomes.
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