ASSA13-15-4 Early Routine Post-Fibrinolysis Angioplasty Compared to Primary Angioplasty in Patients with Acute ST Elevation Myocardial Infarction

Abstract

<h3>Objective</h3> Patients with acute ST-segment elevation myocardial infarction (STEMI), primary angioplasty is often accompanied with myocardial perfusion bad, no-reflow reperfusion that influences both mortality and progression of heart failure, and also is frequently not available or performed beyond the recommended time limit. We designed a randomised, controlled study to evaluate whether early routine post-fibrinolysis angioplasty represents a reasonable reperfusion option for victims of STEMI irrespective of no reflow mechanism and geographic or logistical barriers. <h3>Methods</h3> A total of 936 STEMI patients were randomised to full Urokinase followed by stenting within 3–12 hours of randomization (Early routine post-fibrinolysis angioplasty; 472 patients), or to undergo primary stenting within 6 hours of randomization (primary angioplasty; 464 patients). The primary endpoints were myocardial reperfusion and no-reflow, the extent of myocardial damage, determined by means of the infarct size and the extent of left ventricular myocardial damage, determined by means of the left ventricular function. The secondary endpoints were the acute incidence of bleeding and the 6-month composite incidence of death, reinfarction, stroke, or revascularization. <h3>Results</h3> Early routine post-fibrinolysis angioplasty resulted in higher frequency (P &lt; 0.01) of complete myocardial reperfusion (TIMI 3 myocardial flow) following angioplasty. The primary angioplasty group resulted in higher frequency (P &lt; 0.01) of no-reflow. Both groups were similar regarding infarct size (the level of TroponinT (cTnT), P &gt; 0.05); 6-week left ventricular function (ejection fraction, P &gt; 0.05); major bleeding (P &gt; 0.05) and 6-month cumulative incidence of the clinical endpoint (P &gt; 0.05). <h3>Conclusions</h3> Early routine post-fibrinolysis angioplasty safely results in better myocardial perfusion and lower no-reflow than primary angioplasty. Despite its later application, this approach seems to be equivalent to primary angioplasty in limiting infarct size and preserving left ventricular function.