Abstract
Background: In several countries, fibrinolytic therapy represents the current reperfusion therapy for most patients with STEMI due to decrease of PCI-capable centers. Current guidelines recommended routine early revascularization (within 2-24 h) after successful thrombolysis but, it cannot be performed in timely fashion due to limitation of PCI-capable centers Aim of the work: To assess the utility of the GRACE risk score as prognostic factor in patients receiving delayed coronary intervention after successful thrombolysis in non-PCI-capable hospitals. Methods: This was a prospective observation study that was done from March 2017 to February 2018 and included 120 patients presented to the coronary care unit at Al-Azhar University Hospital and Al Mataryia Teaching Hospital with acute STEMI and treated successfully with thrombolytic therapy. All patients were subjected to full clinical examination, ECGs, Echocardiography, full labs. The patients who had successfully thrombolysis and received delayed PCI (during 48 h to 14 days) were included. Follow up was done on outpatient basis monthly after delayed PCI for three months. Results: There were 70 patients (58.3%) with low GRACE score and 50 patients (41.7%) with high GRACE score. This study showed that more than three quarters of the studied cases had no follow up complications and the most frequent complication was ACS. The percentage of cases which had ACS was 13.3% (number of patients 16), the percentage of cases with HF was 9.2% (number of patients 11), the percentage of cases with stroke was 1.7% (2 patients) and only one case died. During 3 months, the cardiovascular complications occurred in 8 patients in low GRACE group and 20 patients in high GRACE group (P<0.001). Cases with cardiovascular complications had significantly higher time from successful fibrinolysis to PCI (P<0.001). Conclusion: The delayed pharmacoinvasive strategy in patients with intermediate to high GRACE score after successful thrombolysis in non PCI-capable centers was associated with bad cardiovascular outcomes (death, rehospitalization with ACS, rehospitalization with heart failure and cerebrovascular stroke) than the patients with low GRACE score within three months
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