Very Early versus Early Invasive Strategy after Successful Thrombolysis in Patients with ST Segment Elevation Myocardial Infarction

Abstract

Background: Till this time even with superiority of primary percutaneous coronary intervention (pPCI) in the management of ST segment elevation myocardial infarction (STEMI), most of patients present to hospitals without pPCI facilities receive fibrinolytic therapy. The current recommendations support routine early invasive strategy within 24 hours. Objectives: we aimed at evaluating the best timing of invasive strategy within the first 24 hours. Methods: The study was conducted on 60 STEMI patients who were referred to our center after successful thrombolysis. Patients were randomized into 2 groups: Very early invasive group (n=30): subjected to very early invasive strategy within 3 to 12 hours post thrombolysis. Early invasive group (n=30): subjected to early invasive strategy within 12 to 24 hours. The primary endpoints were the composite endpoints of major adverse cardiac events (MACEs). Secondary endpoints were achievement of TIMI III flow with MBG II or III. Safety endpoints were bleeding complications. Results: Both groups were homogenous regarding the demographic, clinical, and angiographic data before invasive strategy. TIMI III flow and MBG II or III were achieved in 83.3% of patients in the very early invasive group vs. 86.6% in the early group (P = 0.955). There was no difference between both groups regarding the composite endpoints MACEs (P= 0.667) or bleeding complications (P=0.528). Conclusion: The study did not demonstrate a correlation between magnitude of benefit and timing of early PCI post successful thrombolysis in patients with STEMI. Thus, early invasive strategy could be scheduled depending on the logistics of the reference catheterization laboratory within 24 hours post thrombolysis.