Key result
A pharmacoinvasive strategy was equivalent to primary PCI for the composite of 30-day mortality, re-MI, and cardiogenic shock in STEMI patients (11.6% vs 18.9%; difference -7.3%).
Why the study?
Does a pharmacoinvasive strategy reduce the composite of mortality, cardiogenic shock, and re-myocardial infarction compared to primary PCI in patients presenting with STEMI?
Observational (n=138)
No
Does a pharmacoinvasive strategy reduce the composite of mortality, cardiogenic shock, and re-myocardial infarction compared to primary PCI in patients presenting with STEMI?
A pharmacoinvasive strategy is equivalent to primary PCI for the management of STEMI in settings where primary PCI may be delayed or unavailable.
Answers are grounded in this paper and cite their sources.
May support pharmacoinvasive strategy when primary PCI is delayed; leaves open confirmation of equivalence in randomized STEMI trials.
Objective: The objective was to study whether the incidence of composite end points (mortality, cardiogenic shock and re-myocardial infarction [re-MI]) in pharmacoinvasive strategy was noninferior to primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI). Methods: This was an observational study which included 138 patients. The study included patients admitted with a diagnosis of STEMI within 24 h of symptom onset, who underwent primary PCI or pharmacoinvasive therapy in a single center over a 9-month period. Primary end points (death within 30 days, re-MI within 30 days, and cardiogenic shock) and secondary end points (arrhythmias, bleeding manifestations, ischemic stroke, ejection fraction, mechanical complications, and duration of hospital stay) were compared between the two groups at 1 month after intervention. Results: At one month follow-up, the incidence rate for primary end points was 5 events per 43 patients (11.6%) in pharmacoinvasive arm and 18 events per 95 patients (18.9%) in primary PCI arm, a difference of - 7.3% (95% confidence interval: 18.5, 7.1). This finding shows that pharmacoinvasive strategy as compared with primary PCI in the management of STEMI was equivalent in terms of composite primary outcome. There was no significant difference between the secondary outcomes between the two groups. Use of thrombus aspiration device and in turn the thrombus burden was significantly lower in the pharmacoinvasive arm. Conclusion: This observational study showed that pharmacoinvasive strategy was as good as primary PCI in STEMI, in our setting, where primary PCI may be delayed or not possible at all due to financial and logistic constraints.
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Alex et al. (2017) conducted an observational in ST-elevation myocardial infarction (STEMI) (n=138). Pharmacoinvasive strategy vs. Primary percutaneous coronary intervention (PCI) was evaluated on Composite of death within 30 days, re-MI within 30 days, and cardiogenic shock (Difference -7.3%, 95% CI 18.5, 7.1). A pharmacoinvasive strategy was equivalent to primary PCI for the composite of 30-day mortality, re-MI, and cardiogenic shock in STEMI patients (11.6% vs 18.9%; difference -7.3%).
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