Impact of Time on Short Term Outcome for Percutaneous Coronary Intervention After Failed Fibrinolysis for Stemi Patients

Background: Although primary percutaneous coronary intervention (PPCI) is the most preferred reperfusion strategy for ST-segment-elevation in myocardial infarction (STEMI), fibrinolytic therapy is considered a valid alternative when PPCI is not feasible or cannot be done within 1 hour after the first medical contact. Objective: To assess the short-term outcome of anterior STEMI patients after failed fibrinolytic therapy, undergoing rescue PCI at 3 different timing scenarios, and to study the effect of delayed intervention on the outcome. Patients and Methods: This study included 63 patients with a diagnosis of anterior STEMI admitted to CCU in Nasser Institute hospital and Sayed Galal University Hospital from December 2016 to August 2018. They received thrombolysis by using streptokinase (1.500.000 IU) without clinical and/or electrocardiographic evidence of successful reperfusion within 90 minutes after the start of fibrinolysis. Patients were referred for rescue PCI within 24 hours. Patients were divided according to time delay from rescue PCI into 3 equal groups: Group A had PCI 3-6 hours after failed thrombolysis, group B had PCI 6-12 hours after failed thrombolysis and group C had PCI 12-24 hours after failed thrombolysis. Patients were studied for the incidence of major adverse cardiac events (MACE), i.e. death; reinfarction, target vessel revascularization (TVR), rehospitalization, symptomatic heart failure and LVEF in the acute stage and after 3 months follow up as primary end points. Left ventricular performance and viability were followed up using low dose dobutamine stress echocardiography as secondary endpoints. Results: Total 63 patients enrolled in the study with mean age 58.60 ± 10.42 years. 84.1% were males and 15.9% were females. Diabetic patients were 65%, hypertensives and smokers were 65% and 42.9% respectively. All patients underwent rescue PCI with bare metal stents (BMS). Three months follow up showed that group A patients had the lowest incidence of MACE (0.0% for Death, reinfarction, TVR, rehospitalization, and highest mean EF 54.14±6.80 (40 - 65) followed by group B (4.7% for death, 9.5% for re-infarction and 47.0% for rehospitalization) with mean EF 41.47±7.60 (30-85) while group C patient had the highest MACE rates and lowest mean LVEF 34.64±5.60 (20 - 40). There was non-significant increase in mortality and TVR rate between the 3 groups. Re-hospitalization showed a statistically significant difference that increased from 0% in group A to 47.0% in group B and 66.6% in group C. Concerning viability assessed by low dose DSE, there were significant difference between groups. In group A, only 4.7% had non-viable infarcted related area, while this percentage increased in group B and C to 38.0% and 100% respectively. Conclusion: Rescue PCI should be done as early as possible for favorable clinical outcome.