Patency Of Infarct-related Artery Research Articles

Early unfractionated heparin treatment in patients with STEMI – trial design and rationale

The early unfractionated heparin (UFH) treatment in patients with ST-elevation myocardial infarction (STEMI) is a single-center, open-label, randomized controlled trial. The study population are patients with STEMI that undergo primary percutaneous coronary intervention (PPCI). The trial was designed to investigate whether early administration of unfractionated heparin immediately after diagnosis of STEMI is beneficial in terms of patency of infarct-related coronary artery (IRA) when compared to established UFH administration at the time of coronary intervention. The patients will be randomized in 1:1 fashion in one of the two groups. The primary efficacy endpoint of the study is Thrombolysis in myocardial infarction (TIMI) flow grades 2 and 3 on diagnostic coronary angiography. Secondary outcome measures are: TIMI flow after PPCI, progression to cardiogenic shock, 30-day mortality, ST-segment resolution, highest Troponin I and Troponin I values at 24 hours. The safety outcome is bleeding complications. The study of early heparin administration in patients with STEMI will address whether pretreatment with UFH can increase the rate of spontaneous reperfusion of infarct-related coronary artery.

Parenteral Anticoagulation at First Medical Contact Improves Infarct Related Artery Patency in STEMI.

(1) Background: Acute ST-segment elevation myocardial infarction (STEMI) remains one of the main morbidity and mortality contributors worldwide. Its main treatment, primary percutaneous coronary intervention (pPCI), can only be performed with a high anticoagulation regimen, usually with heparin. There is still not enough evidence regarding the timing of heparin administration. (2) Methods: We conducted a multicenter observational study of 614 consecutive STEMI patients treated between 2017 and 2019. We split the population in two groups: one that received heparin at the first medical contact, as early as possible, and the second group that received heparin at the PCI capable center or in the cath lab. (3) Results: There was a significantly higher rate of infarct-related artery (IRA) patency at the time of the coronary angiogram in the pre-transfer heparin group than in the on-site heparin group, 44.7% vs. 37.3%, p = 0.042. Also, the early heparin group received shorter and wider stents. There was no difference in bleeding rates or in the in-hospital and two-year mortality rates. (4) Conclusions: Early administration of heparin leads to a higher rate of reperfusion in the IRA, before pPCI, with significant related benefits, such as better stent implantation parameters, without increased bleeding rates.

Neutrophil-to-high-density lipoprotein ratio: an independent predictor of infarct-related artery patency in patients with acute myocardial infarction

Aims: The definition of an infarct-related artery (IRA) is a coronary artery occluded by a thrombus or atheroma that causes ischemia during acute myocardial infarction (AMI). Early patency of the IRA is the primary goal of treatment in patients with AMI. The neutrophil/ high-density lipoprotein cholesterol (HDL-C) ratio (NHR) has been recognized as a new inflammatory marker. We aimed to show the possible relationship between NHR and preprocedural IRA patency.
 Methods: Four hundred patients were screened, and 318 were included in the study after exclusion criteria. IRA flow rate before the coronary procedure was determined according to the previously described thrombolysis in myocardial infarction (TIMI). TIMI current 0,1 and 2 patients were considered IRA non-patent, and TIMI-3 patients were considered IRA patent and were divided into two groups. Regression analysis was performed for possible parameters in predicting IRA patency, evaluated in univariable analysis, and those with p-value

Impact of age on pre-procedural TIMI flow in STEMI patients undergoing primary percutaneous coronary intervention.

Advanced age is a major determinant of impaired prognosis among patients with ST-segment elevation myocardial infarction (STEMI). However, the mechanisms associated with suboptimal reperfusion and enhanced complications are still largely undefined. The aim of the present study was to assess the impact of age on the angiographic findings and the procedural results of primary percutaneous coronary intervention (pPCI) in patients with STEMI. A consecutive cohort of patients admitted for STEMI treated with pPCI were included. Infarct-related artery (IRA) patency was defined for preprocedural TIMI flow 3. We included 520 patients, divided according to age tertiles (<61; 61-72; ≥73). Elderly patients were more often females, with hypertension, renal failure, prior myocardial infarction or PCI, with lower rates of smoking history, haemoglobin, leukocytes and cholesterol (P < 0.001), lower ejection fraction (P = 0.02), higher use of renin angiotensin system inhibitors, statins, ASA, calcium antagonists, diuretics and beta blockers. At angiography, for the IRA, percentage of thrombus (P = 0.02) and stenosis (P = 0.01), direct stenting (P = 0.02) and glycoprotein IIb-IIIa inhibitors (P = 0.04) inversely related with age, but for higher restenosis (P = 0.04). IRA patency was more common in patients aged ≥73 years (27.9% vs. 32.3% vs. 41.1%, P = 0.01). The impact of age on preprocedural TIMI flow was confirmed at multivariate analysis [adjusted odds ratio (95% confidence interval) = 0.68 (0.47-0.98), P = 0.04]. The present study shows that among STEMI patients undergoing primary PCI, more advanced age represents an independent predictor of preprocedural IRA patency. Future studies will define the implications on procedural results and long-term prognosis.

Investigating the Correlation between Serum Amyloid A and Infarct-Related Artery Patency Prior to Percutaneous Coronary Intervention in ST-Segment Elevation Myocardial Infarction Patients.

Serum amyloid A (SAA) is a cardiovascular risk factor and may serve as a predictor of infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). We measured SAA levels in STEMI patients who underwent percutaneous coronary intervention (PCI) and investigated their association with IRA patency. According to the Thrombolysis in Myocardial Infarction (TIMI) flow grade, 363 STEMI patients undergoing PCI in our hospital were divided into an occlusion group (TIMI 0-2) and a patency group (TIMI 3). The SAA level before PCI was significantly higher in STEMI patients with IRA occluded than in those with patent ones. At a cutoff value of 36.9mg/L, SAA had a sensitivity of 63.0% and a specificity of 90.6% (area under the ROC curve [AUC] = .833, 95% CI: .793-.873, P < .001). Multivariate logistic regression analysis showed that SAA was an independent predictor of IRA patency in STEMI patients before PCI (odds ratio [OR] = 1.041, 95% CI: 1.020-1.062, P < .001). SAA can be used as a potential predictor of IRA patency in STEMI patients before PCI.

Relationship Between High Sensitivity C-reactive Protein to Albumin Ratio With Infarct-related Artery Patency in Patients With Non-ST-segment Elevation Myocardial Infarction.

The C-reactive protein/albumin ratio (CAR) has recently emerged as a marker for poor prognosis or mortality in various patient groups. This study aimed to examine the relationship between serum CAR and infarct-related artery (IRA) patency in 700 consecutive non-ST-segment elevation myocardial infarction (NSTEMI) patients prior to percutaneous coronary intervention. The study population was separated into 2 different groups according to preprocedural IRA patency as assessed by the degree of Thrombolysis in Myocardial Infarction (TIMI) flow. As a result, occluded IRA was defined as TIMI grade 0-1, while patent IRA was defined as TIMI grade 2-3. High CAR (Odds Ratio: 3.153 (1.249-8.022); P < .001) was found to be an independent predictor of occluded IRA. Additionally, CAR was positively correlated with the SYNTAX score, neutrophil/lymphocyte ratio, and platelet/lymphocyte ratio; CAR was negatively correlated with left ventricular ejection fraction. The highest cut-off value of CAR predicting occluded IRA was found to be .18 with 68.3% sensitivity and 67.9% specificity. The area under the curve for CAR was .744 (95% CI: .706-.781) after the receiver-operating characteristic curve assessment.

ST-segment yükselmesiz miyokard enfarktüslü hastalarda serum ürik asit/albümin oranı ile tamamen tıkalı enfarkt ilişkili arter arasındaki ilişki

Aim: Infarct-related artery (IRA) patency before primary percutaneous coronary intervention (pPCI) is linked to improved clinical outcomes and lower mortality in patients with acute coronary syndrome. The purpose of this research was to examine the association between serum uric acid/albumin ratio (UAR) and IRA patency in patients with non-ST-segment elevation myocardial infarction (NSTEMI).Material and Method: We evaluated 430 consecutive patients with NSTEMI in total retrospectively. The study population was divided into 2 groups according to the IRA patency as assessed by the degree of Thrombolysis in Myocardial Infarction (TIMI) flow before pPCI. As a result, completely occluded IRA was defined as TIMI grade 0-1, while patent IRA was defined as TIMI grade 2-3.Results: IRA was found to be occluded in 110 (25.5%) patients prior to the procedure. UAR level (p=&amp;lt;0.001) was found to be higher among the patients with IRA occlusion when compared to the patent group. Regression analysis revealed that UAR (OR:3.125; 95% CI:1.186-8.232, p&amp;lt;0.001), left ventricular ejection fraction (OR:0.917, 95% CI:0.885-0.951, p&amp;lt;0.001) and culprit artery diameter (OR:0.917, 95% CI:0.885-0.951, p&amp;lt;0.001) were independent predictors for an occluded IRA. An UAR cut-off value of &amp;gt;1.40 was detected to prognosticate the occluded IRA with 62.7% sensitivity and 63.8% specificity (AUC: 0.722, 95% CI: 0.671-0.773, p&amp;lt;0.001).Conclusion: UAR is an independent predictor of preprocedural IRA patency in patients with NSTEMI. Thus, UAR may be an easily accessible parameter to diagnose high-risk NSTEMI patients who would benefit from an immediate invasive strategy (&amp;lt;2 hours).

TCT-291 Correlation Between Reduced Infarct-Related Artery Patency on Initial Angiography and Post-PCI Reperfusion TIMI Flow in STEMI Patients—A COMPARE CRUSH Subanalysis

TCT-291 Correlation Between Reduced Infarct-Related Artery Patency on Initial Angiography and Post-PCI Reperfusion TIMI Flow in STEMI Patients—A COMPARE CRUSH Subanalysis

Platelet to Lymphocyte Ratio as a Predictor of Infarct-Related Artery Patency in Patients Undergoing Primary Percutaneous Coronary Intervention

Platelet to Lymphocyte Ratio as a Predictor of Infarct-Related Artery Patency in Patients Undergoing Primary Percutaneous Coronary Intervention

The Impact of Lesion Complexity and the CHA2DS2-VASc Score on Spontaneous Reperfusion in Patients with ST-Segment Elevation Myocardial Infarction.

Background In patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI), a patent infarct-related artery (IRA) on initial angiography is defined as spontaneous reperfusion (SR). Objective The present study aimed to determine the impact of lesion complexity and the CHA2DS2-VASc score on SR in patients with STEMI. Methods A total number of 1,641 consecutive patients with STEMI undergoing primary PCI were assessed for this study. Patients were divided into 2 groups, those with SR, SR(+) (n = 239), and those without SR, SR(−) (n = 1402), according to their initial angiography and SR status. CHA2DS2-VASc scores were calculated for all patients. The lesion complexity of coronary artery disease was assessed with the SYNTAX score. Results The CHA2DS2-VASc and SYNTAX scores were significantly lower in the SR(+) group compared to the SR(−) (mean CHA2DS2-VASc, 1.36 ± 0.64 vs. 2.01 ± 0.80, p < 0.001; mean SYNTAX score, 15.51 ± 5.94 vs. 17.08 ± 8.29, p < 0.001). After the multivariate regression analysis, a lower CHA2DS2-VASc (OR = 0.288, p < 0.001), SYNTAX score (OR = 0.920, p=0.007), uric acid (OR = 0.868, p=0.005), CRP (OR = 0.939, p=0.001), BNP (OR = 0.998, p=0.004), and troponin (OR = 0.991, p=0.001) were independent predictors of SR. In-hospital mortality rates were significantly lower in the SR(+) group compared to the SR(−) (0% vs. 6.7%, p < 0.001). Conclusion Our study demonstrated that lesion complexity and the CHA2DS2-VASc score are independently associated with spontaneous reperfusion.

Acute Occlusion of the Infarct-Related Artery as a Predictor of Very Long-Term Mortality in Patients with Acute Myocardial Infarction.

Aim The survey's aim was to examine the significance of infarct-related artery (IRA) occlusion (verified angiographically) on very long-term outcomes of patients with acute myocardial infarction, within the STEMI and NSTEMI diagnosis. Methods A single-center, nonrandomized, registry-based study on patients treated for acute coronary syndrome with percutaneous coronary intervention between June 2011 and December 2016 was conducted. Patients with angiographically proven IRA occlusion (100% stenosis with TIMI flow 0 distal to occlusion) were categorized as occlusive myocardial infarction (OMI) and patients with patent IRA (50–99% stenosis with TIMI 1–3 flow) were categorized as nonocclusive myocardial infarction (NOMI) and very long-term outcomes were analyzed. Data were collected prospectively from the hospital's PCI registry and the database of the Croatian Institute of Public Health. Results A total of 2450 patients were included in the study. 796 (32.5%) patients had NOMI and 1654 patients (67.5%) had OMI. According to ECG changes, 1534 patients presented with STEMI (62,6%) and 916 with NSTEMI (37,8%). 88% of STEMI patients presented with OMI and 12% with NOMI, while patients with NSTEMI in 33,8% presented with OMI and in 66,81% with NOMI. A median follow-up was 4.7 years. There was no significant difference in cardiovascular mortality between the groups (14.8% vs 13.1%; OMI vs NOMI, respectively; p=0.374) neither in all-cause mortality (19% vs 21.5%; OMI vs NOMI, respectively; p=0.374). Patients with NSTEMI had a significantly higher very long-term mortality (21.6% vs 18.1%; NSTEMI vs STEMI, respectively; p=0.029). Conclusion The main findings of the study are as follows: (1) total IRA occlusion was not associated with higher long-term mortality; (2) NSTEMI was associated with a higher mortality rate compared with STEMI, independent of angiographic presentation (OMI/NOMI); (3) IRA occlusion was not associated with significantly higher mortality rates in patients with STEMI and NSTEMI, respectively.

Relationship Between C-Reactive Protein to Albumin Ratio and Infarct-Related Artery Patency in Patients With ST-Segment Elevation Myocardial Infarction.

The C-reactive protein to albumin ratio (CAR) is a predictive marker of systemic inflammatory state in atherosclerotic coronary disease when compared with the predictive value of these 2 markers separately. We investigated the relationship between CAR and infarct-related artery (IRA) patency in patients with ST-segment elevation myocardial infarction (STEMI). The study population (n = 1047) was divided into 2 groups according to IRA patency which was assessed by the Thrombolysis in Myocardial Infarction (TIMI) flow grade. Nonpatent flow was defined as TIMI grade 0 (no-reflow), 1, and 2 flows, and normal flow was defined as TIMI 3 flow. There was a significant positive correlation between CAR and SYNTAX score (r = 0.312, P < .001) and a negative correlation between CAR and TIMI grade flow (r = -0.210, P < .001). At a cutoff level of 0.693, the CAR predicted TIMI no-reflow with a sensitivity of 65.4% and a specificity of 65.5% (area under the curve: 0.670, 95% CI: 0.62-0.71, P < .001). Multivariate logistic regression analyses showed that CAR was an independent predictor of IRA patency (0.003 [0.001-0.029]; P < .001). A higher CAR is a significant and independent predictor of IRA patency in patients with STEMI.

Predictive accuracy of CHA2DS2-VASc score in determining infarct-related artery patency in patients with ST-elevation myocardial infarction

Predictive accuracy of CHA2DS2-VASc score in determining infarct-related artery patency in patients with ST-elevation myocardial infarction

Accuracy of Resolution of ST-Segment Elevation in Electrocardiogram to Determine the Patency of Infarct-Related Artery.

Introduction: There is very limited data comparing the accuracy of ECG to angiography in predicting reperfusion status. In this study, we will determine the accuracy of ECG change i.e. resolution of ST-segment elevation in predicting infarct-related artery (IRA) patency after thrombolysis in patients with ST-segment elevated myocardial infarction (STEMI), in comparison to angiography.Methods: Three hundred and forty-one (n = 341) patients with acute STEMI received streptokinase, a thrombolytic agent within 12 hours of symptoms, and were enrolled in the study via consecutive convenient non-probability sampling. ECG was recorded as soon as the patient arrived in the emergency unit of cardiology. Subsequent ECG was recorded three hours after the administration of streptokinase to look for resolution of ST-segment elevation. ST-segment resolution was classified as greater/equal to 50% resolved or less than 50% resolved. Coronary angiography was performed within 24 hours of hospitalization and flow in the IRA was assessed.Results: The most common site of myocardial infarction (MI) was the anterior wall (50.1%) and the commonest artery involved was the left anterior descending artery (44.2%). On ECG, ST-resolution of more than 50% was found in 242 (70.9%) participants. Thrombolysis in MI (TIMI) grade III flow in angiography was found in 211 (61.8%) participants. The sensitivity and specificity of ST-resolution to detect TIMI grade III flow was 94.79% and 67.69%, respectively, while accuracy was 84.46%.Conclusion: ST-resolution on ECG after streptokinase can predict IRA patency on coronary angiography with moderate to good accuracy. ECG can assist in predicting the impact of streptokinase early in the course of management and give an option of monitoring patient prognosis with a non-invasive test in patients not comfortable with angiography.

Primary percutaneous coronary intervention is appropriate in transient ST-elevation myocardial infarction.

Reperfusion therapy by primary percutaneous coronary intervention (PPCI) is generally indicated in patients suffering from acute myocardial infarction (MI) with ST-segment elevation (STEMI). Prior to hospital admission, full ST-segment resolution (fSTR) may occur. Optimal management of such patients with transient STEMI (TSTEMI) is potentially challenging. Our aim was to evaluate the hypothesis that in TSTEMI patients, patency of infarct related artery (IRA) is achieved before PPCI, and to compare the outcome of TSTEMI and STEMI patients during a prolonged follow-up. Three hundred consecutive adult STEMI patients were referred to catheterization laboratory. In all patients, standard 12 lead ECGs were obtained both at the time of the first medical contact, and on catheterization laboratory admission. TSTEMI occurred in 20 patients (6.7%). Despite fSTR (isoelectric ST segment), occluded IRA was found in 5 of these patients (25%). Pre-PPCI TIMI flow grade 2 was found in 6 TSTEMI patients (30%). Troponin T value at 24 h after symptom onset was lower in the TSTEMI group (1.8±2.5 mg/L vs. 3.6±3.5 mg/L, P=0.008). These patients also had a lower value of brain natriuretic peptide (156.3±119.5 ng/L vs. 438.5±429.0 ng/L, P<0.001) and higher left ventricular ejection fraction (59.9±6.3% vs. 51.6±10.2%, P<0.001). All patients were followed for a median of 5.6 years during which the overall survival did not differ between the TSTEMI and STEMI groups. Primary PCI is strongly recommended in TSTEMI patients because of a relatively high incidence of occluded infarct related arteries. The rate of patients with TSTEMI is relatively low.

Platelet to Lymphocyte Ratio as a Predictor of Infarct-Related Artery Patency in Patients Undergoing Primary Percutaneous Coronary Intervention

Background: In myocardial infarction (MI) patients, myocardial reperfusion and subsequently, early infarct related artery (IRA) patency are very critical in this emergency situation. Recently, there is growing research on the ability of platelet to lymphocyte ratio (PLR) to be a predictor of outcome and its value as a marker for inflammation and coagulopathy detection. Our work aims at finding the relation between PLR and the prognosis of IRA in STEMI patients. Methodology: Two hundred cases presented with STEMI were included for the study. Patency of IRA was estimated by Thrombolysis in Myocardial Infarction (TIMI) grade. Patent IRA was defined as TIMI grade III flow and occluded IRA was defined as TIMI grade 0-II flow. Blood samples were withdrawn on admission at emergency department to calculate PLR. Results: Forty-one (20.5%) cases revealed TIMI 3 flow in IRA before pPCI. Occluded group showed significantly higher PLR than patent group with mean PLR 231.3±94.2 vs 100.95±37.7 respectively with P value <0.0001. Multivariate regression analysis demonstrated, both HTN [95% CI (- 0.135)-(-0.747)] & PLR ratio [95% CI (-0.001)-(-0.002)] together are the most independent predictors for TIMI flow in IRA (F-ratio=12.2, p<0.001). Conclusion: our results show that high Platelet lymphocyte ratio predicts patency of IRA independently in cases with STEMI before pPCI.

A Randomized Study Comparing Patency of Infarction Related Vessel at Time of Primary PCI in Patients Who Received Streptokinase and Who Did Not

Coronary blood flow in an infarct related artery (IRA) in patients that had streptokinase (SK), as the fibrinolytic of choice before percutaneous intervention (PCI), in comparison to the blood flow in patients that underwent primary percutaneous intervention (PPCI) has not been well understood or considered for studies in recent times. All patients presenting with STEMI diagnosis within less than 12 hours from diagnosis either at the centre or referred to the center after SK were screened. 200 patients were randomized into primary PCI (PPCI) or pharmacoinvasive PCI following SK (PhI-SK) administration 3-24 hours after SK. Failed SK patients underwent rescue PCI immediately. The outcome of IRA patency pre- and post PCI in both groups along with short term outcome of bleeding, re-infarction or cardiovascular death in 30 days were looked at. The end points were reached in 81 of 89 (91.0%) in the SK group and 21 of 98 (21.4%) in the PPCI group (p-value <0.001), while TIMI 3 flow was seen in 87 of 89 (98.7%) patients post PCI in the SK group and 69 of 98 (70.4%) patients of PPCI (p-value <0.001). The outcomes of bleeding, MI and death were not different among the groups. We concluded that Fibrinolysis with SK is a viable and safe reperfusion strategy in STEMI especially in low- and middle-income countries (LMICs), where PPCI is not commonly available within the guideline recommended time. It can reduce stress and risk of complications that can occur during PPCI. There is no any difference in the early outcomes of bleeding, MI and death between the two groups.

Can Strain Imaging Predict Left Ventricle Remodeling? A Study from Eastern India

Background: Even persistently patent infarct-related artery has been shown to be associated with left ventricle (LV) remodeling. The purpose of this study was to evaluate the role of LV strain imaging by echocardiography in predicting LV remodeling in patients undergoing coronary revascularization. Materials and Methods: A total of 104 patients between the ages of 18 and 75 years of age undergoing percutaneous transluminal coronary angioplasty (PTCA) for acute coronary syndrome (ACS) were selected and subsequently followed up for 3 months. Echocardiography was obtained before PTCA and subsequently 3 months later with global longitudinal strain (GLS) measurements. Results: In our study, 24% patients studied developed LV remodeling at 1 month even after clinical, angiographic, and procedural success of percutaneous intervention. A value of LV GLS &lt;−10.8 predicted the development of LV remodeling with 80% sensitivity and 86% specificity with lower values having higher specificity. Conclusions: GLS assessment by echocardiography in the acute setting is feasible and easy to do with no complications and may be used with considerable sensitivity in predicting patients with adverse remodeling after ACSs.

Impact of pre-angioplasty antithrombotic therapy administration on coronary reperfusion in ST-segment elevation myocardial infarction: Does time matter?

BackgroundOptimal timing of antithrombotic therapy for patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PPCI) is unclear. We analyzed the impact of pre-angioplasty administration of unfractionated heparin (UFH) on infarct-related artery (IRA) patency and mortality. MethodMulticenter prospective observational study of 3520 STEMI patients treated with PPCI from 2016 to 2018. Subjects were divided into four groups according to the elapsed time from heparin administration to PPCI: Group 1: Upon arrival at catheterization laboratory or ≤ 30 min (n = 800; 22.7%); Group 2: 31 to 60 min (n = 994; 28.2%); Group 3: 61 to 90 min (n = 1091; 31%); Group 4: >90 min (n = 635; 18%). IRA patency was defined as thrombolysis in myocardial infarction (TIMI) flow grade 2–3. Multivariate analyses assessed factors associated with IRA patency and both 30-day and 1-year mortality. ResultsUFH administration at STEMI diagnosis was an independent predictor of IRA patency especially when administered more than 60 min before the PPCI (OR 1.43; 95% CI 1.14–1.81), either an independent predictor of 30-day (HR 0.63; 95% CI 0.42–0.94) and 1-year (HR 0.57; 95% CI 0.41–0.80) mortality. The effect of UFH on IRA patency was higher when administered earlier from the symptom onset. ConclusionUFH administration at STEMI diagnosis improves coronary reperfusion prior to PPCI and this benefit seems associated with superior clinical outcomes. The presented results highlight a time-dependent effectiveness of UFH, since its reported effect is greater the sooner UFH is administered after symptom onset.

The comparison of procedural and clinical outcomes of thrombolytic-facilitated and primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction (STEMI): Findings from PROVE/ACS study.

BACKGROUNDThere is still a controversy in the preferred method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI), when the achievement of well-defined "golden time" is difficult. We sought to evaluate the procedural and in-hospital outcomes of the strategy of "thrombolytic administration and rescue or routine percutaneous coronary intervention (PCI)" versus "primary PCI (PPCI)" strategy in acute STEMI.METHODSIn this observational prospective study, the data of 237 patients with acute STEMI presented or referred to Chamran Cardiovascular Research Center in Isfahan, Iran, were collected (PROVE/ACS study). Baseline characteristics, thrombolysis in myocardial infarction (TIMI) flow grade of infarct-related artery (IRA), left ventricular ejection fraction (LVEF), and in-hospital outcomes were evaluated.RESULTSThe mean age of patients was 61.4 ± 13.0 years, 86.9% were men, 13.1% were diabetic, and 67.9% had anterior STEMI. Patients in the "thrombolytic then PCI" group were younger, more smoker, more often male with higher body weight and lower systolic blood pressure (SBP). The pre-PCI TIMI flow grade 3 was more often seen in the "thrombolytic then PCI" group (39.4% vs. 21.0%, P < 0.001) and less thrombectomy was performed in this group of patients (12.9% vs. 26.7%, P = 0.011). Time to reperfusion was significantly longer in PPCI group (182.4 ± 233.7 minutes vs. 44.6 ± 93.4 minutes, respectively, P < 0.001). No difference in mortality, mean of LVEF, and incidence of atrial fibrillation (AF) was observed in two groups.CONCLUSIONIf the PPCI strategy could not be performed in the golden time, the strategy of thrombolytic administration and rescue or routine PCI leads to more initial IRA patency and less thrombectomy with similar clinical outcomes.