Key result
Fibrinolysis achieved comparable in-hospital and 30-day primary composite outcomes compared to primary percutaneous coronary intervention for STEMI during the COVID-19 pandemic.
Why the study?
Data were lacking to develop uniform recommendations for reperfusion therapies in STEMI during the COVID-19 pandemic.
Does fibrinolysis provide comparable outcomes to primary percutaneous coronary intervention in patients with STEMI during the COVID-19 pandemic?
Cohort (n=78)
Does fibrinolysis provide comparable outcomes to primary percutaneous coronary intervention in patients with STEMI during the COVID-19 pandemic?
Fibrinolysis is a safe and effective alternative to primary PCI for STEMI patients during the COVID-19 pandemic, mitigating the impact of pandemic-related delays in care.
Caution advised before shifting STEMI reperfusion strategies in pandemics; small Level 5 data leaves optimal approach open.
OBJECTIVE: No data are available to develop uniform recommendations for reperfusion therapies in ST-segment elevation myocardial infarction (STEMI) during the coronavirus disease 2019 (COVID-19) pandemic. We aimed to fill the evidence gap regarding STEMI reperfusion strategy during the COVID-19 era. METHODS: Clinical characteristics and outcomes for 17 patients with STEMI who received fibrinolysis during the COVID-19 pandemic were compared with 20 patients who received primary percutaneous coronary intervention (PPCI), and were further compared with another 41 patients who received PPCI in the pre-COVID-19 period. RESULTS: In patients with STEMI, fibrinolysis achieved a comparable in-hospital and 30-day primary composite end point, as compared with those who received PPCI during the COVID-19 pandemic. No major bleeding was detected in either group. Compared patients with STEMI who received PPCI in the pre-COVID-19 period, we found a remarkable extension of chest pain onset-to-first medical contact (FMC) and FMC-to-wire crossing times, significantly increased number and length of stents, and much worse thrombolysis in myocardial infarction flow in patients with STEMI who received PPCI during the COVID-19 pandemic. CONCLUSION: Owing to its considerable efficacy and safety and advantages in conserving medical resources, we recommend fibrinolysis as a reasonable alternative for STEMI care during the COVID-19 pandemic.
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Wang et al. (2020) conducted a cohort in ST-segment elevation myocardial infarction (STEMI) (n=78). Fibrinolysis vs. Primary percutaneous coronary intervention (PPCI) was evaluated on In-hospital and 30-day primary composite end point. Fibrinolysis achieved comparable in-hospital and 30-day primary composite outcomes compared to primary percutaneous coronary intervention for STEMI during the COVID-19 pandemic.
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