Abstract 15557: Comparison of 30-day Mortality by Ischemic Times in ST-Elevation Myocardial Infarction Treated With Pre-Hospital Reduced Dose Fibrinolytic Followed by Percutaneous Coronary Intervention versus Percutaneous Coronary Intervention Alone

Abstract

Introduction: The current standard treatment for ST-elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PPCI). Early reperfusion results in shorter ischemic time (IT) which reduces mortality. In general, fibrinolysis can be initiated earlier than PPCI. For over 7 years we have used a strategy of field evaluation for STEMI using 12 lead ECGs obtained and transmitted by emergency services personnel with over-read by emergency center physicians. Appropriate STEMI patients receive pre-hospital reduced dose fibrinolytic (10 units reteplase) along with aspirin, clopidogrel, and heparin, and are transported to our center for urgent PCI (termed FAST-PCI strategy). Hypothesis: Patients with STEMI in FAST-PCI group have lower 30-day mortality rate compared with those in PPCI group. Methods: Patients with STEMI at our tertiary center were prospectively included for retrospective analysis. Demographic, clinical, angiographic data and outcomes were investigated. Ischemic time was defined as time from onset of pain to device activation. Patients were divided into groups based on IT (<120, 120-179, 180-239, ≥ 240 minutes). Within each IT group, patients were compared by PPCI and FAST-PCI groups. The primary endpoint was 30-day mortality. Results: Between 02/2007 and 12/2013, we treated 1112 STEMI patients of which 551 (49.5%) underwent FAST-PCI and 561 (50.4%) had PPCI. The two treatment groups in each IT interval were well matched for age, cardiac risk factors, left main and left anterior descending artery infarct. Data are shown in the table. Conclusions: For STEMI patients who presented with IT < 180 minutes, FAST-PCI had reduced 30-day mortality rate compared to PPCI. However, a mortality difference was not seen in patients with IT ≥ 180 minutes between the two treatment groups. This suggests that in patients presenting within 3 hours of onset of symptoms FAST-PCI may confer an advantage over PPCI.