Comparison of Pharmacoinvasive PCI and Delayed Regular PCI in ST-Elevation Myocardial Infarction Patients with Short-Term Hospital Outcomes

Abstract

Background: Primary PCI remains a challenge due to the factors like few PCI performing centres, financial issues, delay in timely transfer to such centres. Thus, thrombolytic therapy continues to be the most common reperfusion modality in our setup. The optimal treatment after thrombolysis is still unclear. Objective: To comparison between pharmacoinvasive PCI and delayed routine PCI in ST-elevation myocardial infarction patients with short-term hospital outcomes. Materials and Method: This was a prospective observational comparative study which was conducted in Department of Cardiology, Northeast Medical College, Sylhet, We enrolled total of 120 thrombolysed ST- segment elevation myocardial infarction (STEMI) patients that underwent PCI after considering inclusion and exclusion criteria. Depending on the timing of PCI performed after thrombolysis, two groups were divided as pharmacoinvasive PCI group (refers as PCI performed within 3-24 hrs after thrombolytic therapy) and delayed routine PCI group (refers to PCI performed >24 h to 2 weeks after thrombolytic therapy). In-hospital MACEs (Myocardial re-infarction, target vessel revascularization, heart failure, stroke, and cardiac death) were observed and recorded. All patients were followed up for a period of 30 days. Then findings of 2 groups were compared. Result: In-hospital outcome comparing two groups: incidence of cardiac re-infarction, target vessel revascularization, heart failure and cardiac death were higher in delayed routine PCI group than pharmacoinvasive PCI group (8.2% vs 4.0%, 4.1% vs 2.0%, 10.2% vs 6.0% and 4.1% vs 2.0) and p value (0.329, 0.492, 0.346 and 0.492) respectively, which did not show statistically significant difference. Conclusion: Even after 24 h of thrombolytic treatment in STEMI patients, delayed routine PCI can be performed with comparable outcome to that of PCI within 24 h.