Prehospital Thrombolytic Therapy Prior to Percutaneous Coronary Intervention a Comparative Study with Conventional Approach in Acute ST-segment Elevation Myocardial Infarction

Abstract

Background: early revascularization post MI is the corner stone in the therapy of acute myocardial infarction. Primary PCI proved itself in the management of STEMI with patency rate more than 90%.However, not every hospital has PCI facility. New thrombolytic agent (tenecteplase) is now available which can be given easily outside hospital (Prehospital) to facilitate PCI and preserve the cardiac muscle. Aim of the work: comparing primary PCI results in patients with STEMI when tenecteplase was given prior to intervention as early as possible (Prehospital), with those who had only PCI without thrombolytic therapy. Patients and Methods: the presenting study included 60 patients, divided into two equal groups, group I patients received tenecteplase followed by primary PCI and group II underwent primary PCI only in acute STEMI. 12 leads ECG, cardiac enzymes, echocardiographic study, and coronary angiography were done for all patients. PCI results were recorded in addition to immediate and 6 month follow up. All patients received the same adjuvant medical therapy (aspirin, clopidogrel, heparin and tirofiban if needed). Results: both groups showed non significant differences in peak cardiac enzymes, ejection fraction before and after PCI, and angiographic success post PCI. The hard end points (death, MI) did not show statistical difference between both groups both inhospital and on follow up. However group I showed significant difference (P<0.05) in more direct stenting, less procedure time, and more recurrence of chest pain post PCI compared with group II. There were highly significant differences( P<0.001) in favor of group I in more TIMI 3 flow, less thrombus burden, and less pathological Q waves; and in favor of group II in more clinical success post PCI without complications. The call to balloon interval was shorter in group II (P<0.05). No major bleeding was seen in both groups. Conclusion: facilitated PCI has the advantages of decreasing thrombus burden in acute STEMI, decreasing procedure time and achieving more TIMI 3 flow; however the hard end points are not different from primary PCI and the recurrence of chest pain is significantly more with facilitation. Tenecteplase use is not associated with major bleeding before PCI.