Abstract 6175: The Time-delay that Nullify the Advantage of Primary Percutaneous Coronary Angioplasty over Fibrinolysis is Affected by Patients’ Risk: 1-Hour Does Not Fit All

Abstract

Abstract: Background. The mortality benefit of primary percutaneous coronary angioplasty (PPCI) over fibrinolysis is risk and time dependent. A PPCI-delay > 60 minute nullify the mortality advantage of PPCI. Registry data have shown that the acceptable PPCI-delay depends on the risk of the patient. We explored the relationship between the risk and PPCI-delay leading to equivalent 30-day mortality between PPCI and fibrinolysis by the results of published randomized trials comparing PPCI with fibrinolytic therapy using fibrin specific agents Methods We included 14 trials into final analysis. The DANAMI-2 study, which consisted of 2 substudies was treated as 2 separate trials. When the outcome is mortality, the control (lytic arm) mortality rate can be interpreted as a proxy for mortality risk. We calculated the PPCI-delay as the difference between mean or median door-to-balloon - door-to-needle time and PPCI survival benefit as 30-day mortality after fibrinolysis minus 30-day mortality after PPCI. Results. Multiple regression analysis showed that fibrinolysis mortality risk (regression coefficient 0.96, p <0.001) and PPCI delay (regression coefficient −0.044, p <0.02) were independently correlated with 30-day survival benefit of PPCI without an interaction (p = 0.6). Figure shows the P PCI-delays that lead to equivalent 30-day mortality between PPCI and fibrinolysis according to different risk of the STEMI. Conclusions. The mortality risk of the STEMI patients may modify the acceptable amount of delays to choose a given reperfusion strategy. A longer delay could be justified to choose PPCI instead of fibrinolysis (fibrin specific agents) in high-risk STEMI patients.