Key result
A pharmacoinvasive strategy had a similar incidence of in-hospital death, heart failure, reinfarction, or stroke compared to primary PCI in STEMI patients (RR 1.0; 95% CI 0.98-1.02; p=0.96).
Why the study?
A pharmacoinvasive reperfusion strategy for STEMI when timely primary PCI is unavailable is based on limited trials, and its real-world effectiveness remains unclear.
Does a pharmacoinvasive strategy reduce the composite of death, heart failure, reinfarction, or stroke compared to primary PCI in STEMI patients?
Cohort (n=936)
Yes
Does a pharmacoinvasive strategy reduce the composite of death, heart failure, reinfarction, or stroke compared to primary PCI in STEMI patients?
Relative Risk: 1 (95% CI 0.98–1.02)
p-value: p=0.96
A pharmacoinvasive strategy yields comparable clinical outcomes and safety to primary PCI in real-world STEMI patients, supporting its use when timely primary PCI is unavailable.
Should not alter STEMI reperfusion choices on observational data alone; leaves open pharmacoinvasive role pending randomized confirmation.
Background: A pharmacoinvasive reperfusion strategy is recommended for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (PCI) cannot be achieved in a timely fashion. This is based on a limited number of trials. The effectiveness of this strategy in the real-world is unclear. Objectives: To compare the effectiveness of pharmacoinvasive strategy versus primary PCI using a nationwide prospective registry of STEMI patients. Methods: We examined 936 STEMI patients from the reperfusion in ST-elevation myocardial infarction in Kuwait (REPERFUSE Kuwait) registry who underwent either primary PCI or pharmacoinvasive reperfusion. A composite outcome was measured based on death, congestive heart failure, reinfarction or stroke prospectively ascertained during hospital stay and up to one-year follow-up. The association between reperfusion strategy and the composite outcome was assessed using multivariate regression and Poisson proportional hazard model. Results: Compared to the pharmacoinvasive group, those undergoing primary PCI had higher Killip class on presentation and required more blood transfusions during hospitalization. There was no significant difference between primary PCI and pharmacoinvasive strategy with regards to the incidence of the composite outcome during the in-hospital period (RR = 1.0; 95% CI 0.98-1.02; p = 0.96) after adjustment for possible confounders. Over one-year follow-up, the survival of the two groups was not different (p = 0.66). The incidence of major bleeding was similar in both groups. Conclusion: STEMI patients treated with a pharmacoinvasive strategy have comparable outcomes to those treated with primary PCI with no increased risk of major bleeding. These real-world data support the use of a pharmacoinvasive strategy when primary PCI cannot be achieved in a timely fashion.
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Zubaid et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (n=936). Pharmacoinvasive strategy vs. Primary percutaneous coronary intervention (PCI) was evaluated on Composite of death, congestive heart failure, reinfarction or stroke during hospital stay (RR 1.0, 95% CI 0.98-1.02, p=0.96). A pharmacoinvasive strategy had a similar incidence of in-hospital death, heart failure, reinfarction, or stroke compared to primary PCI in STEMI patients (RR 1.0; 95% CI 0.98-1.02; p=0.96).
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