393 Early presentation STEMI patients benefit more from primary PCI that fibrinolysis

Abstract

Timely primary PCI (PPCI) is the preferred reperfusion therapy for STEMI. However, published data suggests that for early presenters (within “the golden hour” and up to 3-hours from onset of symptoms) fibrinolysis is as effective as PPCI. We examined the use of fibrinolysis and associated outcomes of STEMI patients presenting within 3-hours of onset of symptoms to Calgary hospitals. All STEMI patients captured by STEMI program between January 2004 and December 2010 were analyzed. From all STEMI patients presenting to Calgary hospitals (n = 2579), a total of 1975 patients presented within 3-hours of symptoms onset. The proportion of early presenters receiving fibrinolytics significantly increased over last 3 years (P <0.001) (Figure 1), though still used rather rarely. The early presenters receiving fibrinolysis had significantly higher 30-day mortality as compare to patients undergoing PPCI (11.0% vs. 3.5% respectively; P = 0.001). Our data suggests that fibrinolysis should be used with caution in early presentation STEMI patients if cardiac catheterization facility with PCI capability is available in timely matter. Further studies are necessary to better understand the cause(s) of unexpected survival difference reported here.