A pharmacoinvasive strategy significantly reduced infarction size compared to fibrinolysis followed by ischemia-driven PCI in patients with early STEMI.
RCT (n=60)
Single-blind (operator blinded for CMR)
Simple randomization tables
Yes
Does a pharmacoinvasive strategy using streptokinase followed by early PCI reduce infarction size and microvascular obstruction in patients with acute STEMI compared to primary PCI or ischemia-driven PCI?
A pharmacoinvasive strategy using streptokinase followed by early PCI reduces infarct size and microvascular obstruction compared to an ischemia-driven approach in STEMI patients unable to undergo primary PCI within 2 hours, though it increases minor bleeding.
Absolute Event Rate: 27580% vs 49770%
p-value: p=0.02
BACKGROUND: The rationale for pharmacoinvasive strategy is that many patients have a persistent reduction in flow in the infarct-related artery. The aim of the present study is to assess safety and efficacy of pharmacoinvasive strategy using streptokinase compared to primary PCI and ischemia driven PCI on degree of myocardial salvage and outcomes. METHODS AND RESULTS: Sixty patients with 1st attack of acute STEMI within 12 h were randomized to 4 groups: primary PCI for patients presented to PPCI-capable centers (group I), transfer to PCI if presented to non-PCI capable center (group II), pharmacoinvasive strategy "Streptokinase followed by PCI within 3-24 h" (group III) and fibrinolytic followed by ischemia driven PCI (group IV). The primary endpoint is the infarction size and microvascular obstruction (MVO) measured by cardiac MRI (CMR) 3-5 days post-MI. Pharmacoinvasive strategy led to a significant reduction in infarction size, MVO and major adverse cardiac and cerebrovascular event (MACCE) compared to group IV but minor bleeding was significantly higher compared to other groups. CONCLUSIONS: Pharmacoinvasive strategy resulted in effective reperfusion and smaller infarction size in patients with early STEMI who could not undergo primary PCI within 2 h after the first medical contact. This can provide a wide time window for PCI when the application of primary PCI within the optimal time limit is not possible. However, it was associated with a slightly increased risk of minor bleeding.
Helal et al. (Fri,) conducted a rct in ST elevation myocardial infarction (STEMI) (n=60). Pharmacoinvasive strategy (Streptokinase followed by PCI within 3-24 h) vs. Ischemia-driven PCI (Streptokinase followed by PCI only for ischemia) was evaluated on Infarction size measured by cardiac MRI (CMR) at 3-5 days post-MI (mm3) (p=0.02). A pharmacoinvasive strategy significantly reduced infarction size compared to fibrinolysis followed by ischemia-driven PCI in patients with early STEMI.