Key result
Primary PCI yields a modest improvement in discharge LVEF compared with a pharmaco-invasive strategy.
Why the study?
Primary PCI is the gold standard for STEMI reperfusion, but the comparative effectiveness of pharmaco-invasive thrombolytic therapy versus primary PCI requires evaluation.
Does a pharmaco-invasive strategy with thrombolysis improve discharge LVEF and in-hospital outcomes compared to primary PCI in patients with STEMI?
RCT (n=62)
Equally divided
No
Does a pharmaco-invasive strategy with thrombolysis improve discharge LVEF and in-hospital outcomes compared to primary PCI in patients with STEMI?
p-value: p=0.0004
Primary PCI was associated with a modest improvement in adjusted discharge LVEF compared to a pharmacoinvasive strategy, though short-term clinical complications and mortality were similar.
Background: If you have an ST-segment elevation myocardial infarction (STEMI), you must get reperfusion quickly. The gold standard is PCI, but in situations where it isn't possible, pharmaco-invasive therapy with thrombolysis can be useful. Aim: In order to compare primary percutaneous coronary intervention (PCI) with a pharmaco-invasive technique that uses thrombolytic treatment and evaluate the results of both approaches. Subjects and methods: A total of 62-STEMI patients were enrolled and equally divided into thrombolysis (n=31) and primary PCI (n=31) groups. Baseline demographics, cardiovascular risk factors, clinical presentation, laboratory values, echocardiographic parameters, and in-hospital outcomes were assessed. Left ventricular ejection fraction (LVEF) at discharge was analyzed using multivariable regression and ANCOVA. Results: Comparable baseline characteristics and comorbidities existed between groups. Primary PCI patients had greater rates of delayed presentation (>12 hours) and incorrect self-diagnosis (p=0.020). Cardiogenic shock on admission was more common in primary PCI (12.9% vs 0%, p=0.039). Hemoglobin levels were considerably higher in the thrombolysis group upon admission and peak (p<0.01). Discharge 3D-LVEF favored primary PCI (p=0.065), while admission and discharge LVEF were identical. Multivariable linear regression did not predict discharge LVEF. Adjusted for entry LVEF, ANCOVA after adjustment showed a significant treatment effect favoring primary PCI (F=14.374, p=0.0004; partial η²=0.196). In-hospital complications and mortality were modest and equivalent among groups. Conclusion: In this randomized single-center study, primary PCI was associated with modest improvement in discharge LVEF after adjustment for baseline differences, while short-term clinical outcomes were similar between groups. These findings suggest potential functional benefit with primary PCI; however, larger studies with longer follow-up are needed to confirm these results.
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Rohiem et al. (2026) conducted an RCT in ST-segment elevation myocardial infarction (STEMI) (n=62). Primary percutaneous coronary intervention (PCI) vs. Pharmaco-invasive strategy (thrombolysis) was evaluated on Discharge left ventricular ejection fraction (LVEF) (p=0.0004). Primary percutaneous coronary intervention was associated with a modest improvement in discharge LVEF compared to a pharmaco-invasive strategy after adjustment for baseline differences (p=0.0004).
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