Primary percutaneous coronary intervention versus fibrinolytic therapy combined with early coronary catheterization using the left radial approach

Abstract

Objectives The objectives of this study were to compare primary percutaneous coronary intervention (PCI) with the strategy of fibrinolysis combined with coronary angiography within 6–24 h in ST-segment elevation myocardial infarction (STEMI) patients who presented within 3 h of symptom onset. Background Guidelines for acute STEMI patients recommend primary PCI as the favorable reperfusion strategy. This approach is contingent on performing PCI in a timely manner. Most patients do not attend PCI-capable hospitals; this factor has led to major challenge in many regions. Patients and methods This was a prospective, single-center study that included 100 consecutive STEMI patients admitted to the ER Unit at the National Heart Institute between June 2013 and December 2015. Cases were divided into the following groups: group A included 50 STEMI patients with onset of symptoms within 3 h and received fibrinolysis with streptokinase followed by timely coronary artery with or without PCI using the left redial approach, and group B included 50 patients who underwent primary PCI. In-hospital outcomes were reviewed and reported after 30 days. Results No statistically significant differences among groups were found with respect to mean age, sex, pulse, blood pressure, prevalence of previous stroke, peripheral arterial disease, previous myocardial infarction, previous PCI or previous coronary artery bypass graft, the duration from onset of symptoms to emergency department (ED) arrival, number of vessels treated, maximum inflation pressure, use of drug eluting stents, number of stents at target lesion, stent length, total stent length, mean nominal stent diameter, and incidence of cardiac deaths. In contrast, highly significant differences were observed in both groups regarding the prevalence of visible thrombus (P = 0.00), initial diameter stenosis (P = 0.031), total occlusion (P = 0.00), and baseline TIMI flow grade (P = 0.00) as the incidence was significantly higher in group B compared with group A. Highly significant differences were observed among group A and group B regarding severe bleeding, heart failure, and overall complications (P = 0.00 for all). Conclusion Left radial strategy for primary/delayed PCI in acute elevation of ST patients with previous myocardial infarction is feasible, safe, and successful with low incidence of complications. Early fibrinolytic therapy combined with early percutaneous intervention is a favorable choice for management of acute STEMI patients.