Cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI in Thailand: a randomised trial

Abstract

BackgroundThe benefit of an early coronary intervention after streptokinase (SK) therapy in low to intermediate-risk patients with ST-elevation myocardial infarction (STEMI) still remains uncertain. The current study aimed to evaluate the cardiovascular outcomes of early versus delayed coronary intervention in low to intermediate-risk patients with STEMI after successful therapy with SK.MethodsWe randomly assigned low to intermediate Global Registry of Acute Coronary Events risk score to patients with STEMI who had successful treatment with full-dose SK at Lampang Hospital and Maharaj Nakorn Chiang Mai Hospital into early and delayed coronary intervention groups. The primary endpoints were 30-day and 6-month composite cardiovascular outcomes (death, rehospitalised with acute coronary syndrome, rehospitalised with heart failure and stroke).ResultsOne hundred and sixty-two patients were included in our study. At the 30 days, composite cardiovascular outcomes were 4.9% in the early coronary intervention group and 2.5% in the delayed group (p=0.682). At the 6 months, the composite cardiovascular outcomes were 16.1% in the early group and 6.2% in the delayed group (p=0.054).ConclusionsThe delayed coronary intervention (>24 hours) in low to intermediate STEMI after successful therapy with SK did not increase in short and long-term cardiovascular events compared with an early coronary intervention.Trial registration numberNCT02131103.

Respuesta a la carta al editor «Poniéndole la lupa a la estrategia farmacoinvasiva»

“…(2019) * (11) Estudio aleatorizado. Pacientes fibrinolizados con éxito, con GRACE bajo a intermedio (< 155).…”

“…Sin embargo, ante la interrogante planteada, de un escenario que sucede con frecuencia en nuestro deficiente sistema de salud, ¿qué conducta tomar si por cualquier problema el centro que realiza la fibrinolisis exitosa no puede transferir al paciente dentro de las primeras 24 h para la ICP? En este contexto, la evidencia científica disponible, proveniente principalmente de estudios observacionales (Tabla 1), indica resultados similares de la ICP luego de las 24 h respecto a la ICP en las primeras 24 h tras una fibrinolisis exitosa, y respaldan buscar transferir siempre a todos los pacientes, para completar la estrategia farmacoinvasiva, lo más pronto posible, independientemente de sus características individuales (8)(9)(10)(11)(12)(13)(14)(15) ya que tienen riesgo de isquemia recurrente y reinfarto que podrían conducir a menor función ventricular y mayor probabilidad de muerte (16,17) .…”