A comparison of outcomes with adjunctive and delayed routine pharmacoinvasive percutaneous coronary intervention strategy after thrombolysis in patients with ST-elevation myocardial infarction: Experience from a tertiary-care center in India

• Main Authors: Akhil Kumar Sharma, Vikas Kumar, Gaurav Kumar Chaudhary, Mahim Saran, Varun Shankar Narain, Sudhanshu Kumar Dwivedi, Sharad Chandra
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2018-01-01
• Series: Heart India
• Subjects: Coronary angiography; left-ventricular ejection fraction; percutaneous coronary intervention; ST-elevation myocardial infarction; thrombolytic therapy
• Online Access: http://www.heartindia.net/article.asp?issn=2321-449x;year=2018;volume=6;issue=4;spage=141;epage=147;aulast=Sharma

Objective: Since primary percutaneous coronary intervention (PCI) is not readily available to many patients either due to financial issue or unavailability of invasive cath labs, pharmacoinvasive strategies are now becoming the de facto treatment strategy. The most commonly used strategies are adjunctive PCI (within 3–24 h of thrombolysis) and delayed routine PCI (>24 h to before hospital discharge). However, direct comparison of these two strategies is lacking. Materials and Methods: In this prospective, observational, single-center study, a total of 113 thrombolysed ST-segment elevation myocardial infarction (STEMI) patients in the adjunctive PCI group and 127 thrombolysed STEMI patients in the delayed routine PCI group were analyzed. At 30-day follow-up, patients were evaluated for all-cause mortality, reinfarction, hospitalization due to angina, hospitalization due to heart failure, and improvement in left ventricular (LV) ejection fraction. Results: Patients in the adjunctive PCI group and those in the delayed routine PCI group exhibited comparable baseline characteristics. At 30-day follow up, no significant difference was noted in all-cause mortality, reinfarction, hospitalization due to angina, and hospitalization due to heart failure. There was slight trend toward increased composite end-points in the adjunctive PCI group, probably favoring delayed routine PCI (8.85% vs. 4.72%; P = 0.450). There was no significant difference in improvement in LV ejection fraction between two groups (P = 0.671). Conclusions: Even after 24 h of thrombolytic treatment in STEMI patients, delayed routine PCI can be performed with comparable outcome to that of PCI within 24 h.