Key result
A pharmaco-invasive strategy for STEMI was associated with lower 3-year mortality compared to primary PCI (6.2% vs 11.1%, P<0.01), particularly when primary PCI was delayed.
Why the study?
Pharmaco-invasive PCI is recommended for STEMI patients unable to undergo timely primary PCI, but late outcomes compared with timely and late primary PCI needed examination.
Does a pharmaco-invasive strategy improve mortality compared to primary PCI in STEMI patients presenting within 12 hours of symptom onset?
Cohort (n=2,091)
No
Does a pharmaco-invasive strategy improve mortality compared to primary PCI in STEMI patients presenting within 12 hours of symptom onset?
Absolute Event Rate: 6.2% vs 11.1%
p-value: p=<0.01
A pharmaco-invasive strategy is associated with lower mortality than late primary PCI in STEMI patients when timely primary PCI is unavailable.
May support pharmaco-invasive strategy when primary PCI is delayed; leaves open need for randomized confirmation.
AIMS: Pharmaco-invasive percutaneous coronary intervention (PI-PCI) is recommended for patients with ST-elevation myocardial infarction (STEMI)who are unable to undergo timely primary PCI (pPCI). The present study examined late outcomes after PI-PCI (successful reperfusion followed by scheduled PCI or failed reperfusion and rescue PCI)compared with timely and late pPCI (>120 min from first medical contact). METHODS AND RESULTS: All patients with STEMI presenting within 12 h of symptom onset, who underwent PCI during their initial hospitalization at Liverpool Hospital (Sydney), from October 2003 to March 2014, were included. Amongst 2091 STEMI patients (80% male), 1077 (52%)underwent pPCI (68% timely, 32% late), and 1014 (48%)received PI-PCI (33% rescue, 67% scheduled). Mortality at 3 years was 11.1% after pPCI (6.7% timely, 20.2% late) and 6.2% after PI-PCI (9.4% rescue, 4.8% scheduled); P < 0.01. After propensity matching, the adjusted mortality hazard ratio (HR) for timely pPCI compared with scheduled PCI was 0.9 (95% CIs 0.4-2.0) and compared with rescue PCI was 0.5 (95% CIs 0.2-0.9). The adjusted mortality HR for late pPCI, compared with scheduled PCI was 2.2 (95% CIs 1.2-3.1)and compared with rescue PCI, it was 1.5 (95% CIs 0.7-2.0). CONCLUSION: Patients who underwent late pPCI had higher mortality rates than those undergoing a pharmaco-invasive strategy. Despite rescue PCI being required in a third of patients, a pharmaco-invasive approach should be considered when delays to PCI are anticipated, as it achieves better outcomes than late pPCI.
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Jamal et al. (2022) conducted a cohort in ST-elevation myocardial infarction (STEMI) (n=2,091). Pharmaco-invasive percutaneous coronary intervention vs. Primary percutaneous coronary intervention (timely and late) was evaluated on Mortality at 3 years (p=<0.01). A pharmaco-invasive strategy for STEMI was associated with lower 3-year mortality compared to primary PCI (6.2% vs 11.1%, P<0.01), particularly when primary PCI was delayed.
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