Abstract 17066: Efficacy and Safety of the Pharmacoinvasive Strategy Compared With Primary Percutaneous Coronary Intervention in Patients Initially Presenting to Hospital Centers Without Capacity for Coronary Intervention

Abstract

Introduction: Primary PCI (pPCI) is the preferred treatment for reperfusion in STEMI patients. However, its feasibility in real-world scenarios raises questions about the effectiveness of the pharmacoinvasive strategy compared to pPCI for patients arriving at a healthcare facility without a catheterization laboratory. Hypothesis : A pharmacoinvasive strategy is more effective than transferring STEMI patients to a PCI-equipped hospital for those initially presenting to non-PCI centers. Aims: To compare the efficacy of the pharmacoinvasive strategy versus referral for primary PCI in STEMI patients initially presenting at non-PCI centers. Methods: This study is a pre-specified subanalysis of the PHASE-Mx registry (NCT NCT03974581), including consecutive STEMI patients from Mexico City treated within 12 hours of symptom onset. Patients received either the pharmacoinvasive strategy or were referred for pPCI. The primary composite endpoint was cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure at 30-day follow-up. Results: A total of 634 patients were included, with 61.3% treated with the pharmacoinvasive strategy and 38.6% referred for pPCI. Mean age was 58.3 (+/-10 years), and the majority were men (85.3%). Compared to those transferred for pPCI, pharmacoinvasive strategy showed a significant reduction in the risk of the primary endpoint beyond 30 days, with a hazard ratio (HR) of 0.60 (95% CI 0.39-0.94, p = 0.02). This risk reduction was primarily driven by a significant decrease in heart failure risk (HR 0.57, 95% CI 0.35-0.93, p = 0.025). Conclusions: Pharmacoinvasive strategy in STEMI patients initially attending hospitals without PCI capability resulted in a 40% risk reduction for cardiovascular death, heart failure, cardiogenic shock, and recurrent infarction at 30-day follow-up compared to referral for pPCI.