Key result
Pharmacoinvasive strategy matches PPCI for in-hospital mortality but links to ~3.4-fold higher cardiogenic shock.
Why the study?
Although primary percutaneous coronary intervention is guideline-recommended for STEMI, access limitations are a major challenge in middle-income countries. A pharmacoinvasive strategy has been proposed as a pragmatic alternative, but real-world comparative data remain limited.
Does a pharmacoinvasive strategy affect in-hospital mortality and cardiogenic shock compared with primary percutaneous coronary intervention in patients with STEMI in a real-world Brazilian setting?
Observational (n=5,941)
Yes
Does a pharmacoinvasive strategy affect in-hospital mortality and cardiogenic shock compared with primary percutaneous coronary intervention in patients with STEMI in a real-world Brazilian setting?
Answers are grounded in this paper and cite their sources.
In a large Brazilian STEMI cohort, a pharmacoinvasive strategy yielded similar in-hospital mortality to primary PCI (5.9% vs 5.8%) but was associated with a markedly higher rate of cardiogenic shock (8.9% vs 2.6%), reinforcing the priority of timely primary PCI.
Background Early reperfusion is the cornerstone of ST-segment elevation myocardial infarction (STEMI) management, with treatment delays directly influencing mortality and haemodynamic complications. Although primary percutaneous coronary intervention (PPCI) is the guideline-recommended strategy, access limitations remain a major challenge in middle-income countries. The pharmacoinvasive (PI) strategy has been proposed as a pragmatic alternative, yet real-world comparative data remain limited. We evaluated in-hospital mortality and cardiogenic shock in patients treated with PPCI versus PI strategy. Methods In this multicentre observational study, 5,941 consecutive STEMI patients were included: 3,240 underwent PPCI (2014–2020) and 2,701 received PI strategy (2010–2020). Clinical characteristics, angiographic findings, and system delays (symptom-to-reperfusion and door-to-reperfusion times) were analysed. Multivariable logistic regression adjusted for clinical and haemodynamic covariates was performed, with results expressed as adjusted prevalence ratios (aPR) and 95% confidence intervals. Results PPCI patients were older, whereas smoking was more prevalent in the PI group. Diabetes and hypertension were similarly distributed. Reperfusion times were significantly shorter with PPCI, which was also associated with higher rates of final TIMI 3 flow and myocardial blush grade 3(Table 1). In-hospital mortality was comparable between PPCI and PI strategy (5.8% vs 5.9%; p=0.94). However, cardiogenic shock occurred more frequently in the PI group (8.9% vs 2.6%; p<0.001). After adjustment, age and diabetes independently predicted mortality. The PI strategy was not associated with increased mortality but remained strongly associated with cardiogenic shock (Figure 1B). Conclusion In this large real-world cohort, the pharmacoinvasive strategy achieved similar in-hospital mortality compared with PPCI but was associated with a markedly higher risk of cardiogenic shock. These findings reinforce the priority of timely PPCI and highlight the need for optimised regional STEMI networks in resource-limited settings.
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Barbosa et al. (2026) conducted an observational in ST-segment elevation myocardial infarction (STEMI) (n=5,941). Pharmacoinvasive strategy vs. Primary percutaneous coronary intervention was evaluated on In-hospital mortality (p=0.94). The pharmacoinvasive strategy achieved comparable in-hospital mortality to PPCI but had higher cardiogenic shock rates.
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