Key result
A pharmacoinvasive strategy was comparable to primary PCI for the 30-day composite of cardiovascular death, shock, recurrent MI, or heart failure (HR 0.76; 95% CI 0.48-1.21; P=0.24).
Why the study?
A pharmacoinvasive strategy is reasonable when primary PCI cannot be delivered timely, but its efficacy and safety compared with primary PCI in a real-world setting needed assessment.
Does a pharmacoinvasive strategy reduce cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure compared to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction?
Cohort (n=579)
Does a pharmacoinvasive strategy reduce cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure compared to primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction?
Hazard Ratio: 0.76 (95% CI 0.48–1.21)
p-value: p=0.24
A pharmacoinvasive strategy is an effective and safe alternative to primary PCI for STEMI patients when timely access to primary PCI is limited, showing comparable 30-day cardiovascular and bleeding outcomes.
Supports PIs as alternative when timely PCI unavailable in LMICs; hypothesis-generating and requires randomized confirmation.
Background A low proportion of patients with ST-elevation myocardial infarction (STEMI) in low- to middle-income countries receive reperfusion therapy. Although primary percutaneous coronary intervention (PCI) is the method of choice, a pharmacoinvasive strategy (PIs) is reasonable when primary PCI cannot be delivered on a timely basis. The aim of our study was to assess the efficacy and safety of a PIs compared with primary PCI in a real-world setting. Methods This was a prospective registry that included patients with STEMI who received reperfusion during the first 12 hours from symptom onset. The primary composite end point was the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure at 30 days according to the reperfusion strategy used. The key safety end point was major bleeding (Bleeding Academic Research Consortium [BARC] score 3-5) at 30 days. Results We included 579 patients with STEMI, 49.7% underwent primary PCI and 50.2% received PIs. Those who received a PIs approach were more likely to present with Killip class > 1 and to have a history of diabetes but were less likely to have a previous cardiovascular disease diagnosis. No statistically significant difference was shown in the primary composite end point according to reperfusion strategy (hazard ratio for PIs, 0.76; 95% confidence interval, 0.48-1.21; P = 0.24). Major bleeding was not different among groups (hazard ratio for PIs, 0.92; 95% confidence interval, 0.45-1.86; P = 0.81). Two patients in the PIs group (0.6%) and no patients in the PCI group had intracranial bleeding ( P = 0.15). Conclusions In this prospective real-world registry, major cardiovascular outcomes and bleeding were not different among patients who underwent a PIs or primary PCI. The study suggests that a PIs is an effective and safe option for patients with STEMI when access to primary PCI is limited.
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Araiza‐Garaygordobil et al. (2020) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=579). Pharmacoinvasive strategy vs. Primary percutaneous coronary intervention (PCI) was evaluated on Cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure at 30 days (HR 0.76, 95% CI 0.48-1.21, p=0.24). A pharmacoinvasive strategy was comparable to primary PCI for the 30-day composite of cardiovascular death, shock, recurrent MI, or heart failure (HR 0.76; 95% CI 0.48-1.21; P=0.24).
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