The comparison of procedural and clinical outcomes of thrombolytic-facilitated and primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction (STEMI): Findings from PROVE/ACS study

BACKGROUND: There is still a controversy in the preferred method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI), when the achievement of well-defined "golden time" is difficult. We sought to evaluate the procedural and in-hospital outcomes of the strategy of "thrombolytic administration and rescue or routine percutaneous coronary intervention (PCI)" versus "primary PCI (PPCI)" strategy in acute STEMI.METHODS: In this observational prospective study, the data of ۲۳۷ patients with acute STEMI presented or referred to Chamran Cardiovascular Research Center in Isfahan, Iran, were collected (PROVE/ACS study). Baseline characteristics, thrombolysis in myocardial infarction (TIMI) flow grade of infarct-related artery (IRA), left ventricular ejection fraction (LVEF), and in-hospital outcomes were evaluated.RESULTS: The mean age of patients was ۶۱.۴ ± ۱۳.۰ years, ۸۶.۹% were men, ۱۳.۱% were diabetic, and ۶۷.۹% had anterior STEMI. Patients in the "thrombolytic then PCI" group were younger, more smoker, more often male with higher body weight and lower systolic blood pressure (SBP). The pre-PCI TIMI flow grade ۳ was more often seen in the "thrombolytic then PCI" group (۳۹.۴% vs. ۲۱.۰%, P < ۰.۰۰۱) and less thrombectomy was performed in this group of patients (۱۲.۹% vs. ۲۶.۷%, P = ۰.۰۱۱). Time to reperfusion was significantly longer in PPCI group (۱۸۲.۴ ± ۲۳۳.۷ minutes vs. ۴۴.۶ ± ۹۳.۴ minutes, respectively, P < ۰.۰۰۱). No difference in mortality, mean of LVEF, and incidence of atrial fibrillation (AF) was observed in two groups.CONCLUSION: If the PPCI strategy could not be performed in the golden time, the strategy of thrombolytic administration and rescue or routine PCI leads to more initial IRA patency and less thrombectomy with similar clinical outcomes. 

کلیدواژه ها:

ST Segment Elevation Myocardial Infarction ، Percutaneous Coronary Intervention ، Thrombolytic Therapy ، Treatment Outcome ، Reperfusion