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Primary PCI versus pharmacoinvasive strategy for ST elevation myocardial infarction.
Int J Cardiol Heart Vasc 2018; 21:87-93IJ

Abstract

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.

Authors+Show Affiliations

Faculty of Medicine, Fayoum University, Cairo, Egypt.Faculty of Medicine, Ain-Shams University, Cairo, Egypt.Faculty of Medicine, Ain-Shams University, Cairo, Egypt.Faculty of Medicine, Ain-Shams University, Cairo, Egypt.Faculty of Medicine, Ain-Shams University, Cairo, Egypt.Faculty of Medicine, Ain-Shams University, Cairo, Egypt.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

30402534

Citation

Helal, Ayman M., et al. "Primary PCI Versus Pharmacoinvasive Strategy for ST Elevation Myocardial Infarction." International Journal of Cardiology. Heart & Vasculature, vol. 21, 2018, pp. 87-93.
Helal AM, Shaheen SM, Elhammady WA, et al. Primary PCI versus pharmacoinvasive strategy for ST elevation myocardial infarction. Int J Cardiol Heart Vasc. 2018;21:87-93.
Helal, A. M., Shaheen, S. M., Elhammady, W. A., Ahmed, M. I., Abdel-Hakim, A. S., & Allam, L. E. (2018). Primary PCI versus pharmacoinvasive strategy for ST elevation myocardial infarction. International Journal of Cardiology. Heart & Vasculature, 21, pp. 87-93. doi:10.1016/j.ijcha.2018.10.006.
Helal AM, et al. Primary PCI Versus Pharmacoinvasive Strategy for ST Elevation Myocardial Infarction. Int J Cardiol Heart Vasc. 2018;21:87-93. PubMed PMID: 30402534.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary PCI versus pharmacoinvasive strategy for ST elevation myocardial infarction. AU - Helal,Ayman M, AU - Shaheen,Sameh M, AU - Elhammady,Walid A, AU - Ahmed,Mohamed I, AU - Abdel-Hakim,Ahmed S, AU - Allam,Lamyaa E, Y1 - 2018/10/27/ PY - 2018/08/28/received PY - 2018/10/16/revised PY - 2018/10/18/accepted PY - 2018/11/8/entrez PY - 2018/11/8/pubmed PY - 2018/11/8/medline KW - Cardiac MRI (CMR) KW - Infarction size KW - Microvascular obstruction (MVO) KW - Pharmacoinvasive strategy KW - Primary PCI SP - 87 EP - 93 JF - International journal of cardiology. Heart & vasculature JO - Int J Cardiol Heart Vasc VL - 21 N2 - 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. SN - 2352-9067 UR - https://www.unboundmedicine.com/medline/citation/30402534/Primary_PCI_versus_pharmacoinvasive_strategy_for_ST_elevation_myocardial_infarction L2 - https://linkinghub.elsevier.com/retrieve/pii/S2352-9067(18)30109-X DB - PRIME DP - Unbound Medicine ER -