Comparison of Thrombolysis Followed by Broad Use of Percutaneous Coronary Intervention With Primary Percutaneous Coronary Intervention for ST-Segment–Elevation Acute Myocardial Infarction

Abstract

Background-Intravenous thrombolysis remains a widely used treatment for ST-elevation myocardial infarction; however, it carries a higher risk of reinfarction than primary PCI (PPCI). There are few data comparing PPCI with thrombolysis followed by routine angiography and PCI. The purpose of the present study was to assess contemporary outcomes in ST-elevation myocardial infarction patients, with specific emphasis on comparing a pharmacoinvasive strategy (thrombolysis followed by routine angiography) with PPCI. Methods and Results-This nationwide registry in France included 223 centers and 1714 patients over a 1-month periodat the end of 2005, with 1-year follow-up. Sixty percent of the patients underwent reperfusion therapy, 33% with PPCI and 29% with intravenous thrombolysis (18% prehospital). At baseline, the Global Registry of Acute Coronary Events score was similar in thrombolysis and PPCI patients. Time to initiation of reperfusion therapy was significantly shorter in thrombolysis than in PPCI (median 130 versus 300 minutes). After thrombolysis, 96% of patients had coronary angiography, and 84% had subsequent PCI (58% within 24 hours). In-hospital mortality was 4.3% for thrombolysis and 5.0% for PPCI. In patients with thrombolysis, 30-day mortality was 9.2% when PCI was not used and 3.9% when PCI was subsequently performed (4.0% if PCI was performed in the same hospital and 3.3% if performed after transfer to another facility). One-year survival was 94% for thrombolysis and 92% for PPCI (Pϭ0.31). After propensity score matching, 1-year survival was 94% and 93%, respectively. Conclusions-When used early after the onset of symptoms, a pharmacoinvasive strategy that combines thrombolysis with a liberal use of PCI yields early and 1-year survival rates that are comparable to those of PPCI. (Circulation. 2008;118: 268-276.)

Acute myocardial infarction system of care in the third world

“…For example, models of STEMI systems of care include that in Vienna with its city-wide system of care [10], France with the famous SAMU-nationwide system [11], Minneapolis [12] and Mayo clinic [13] with their regional system of care. Although they have some differences in the protocol, all of the systems are using a pharmaco-invasive approach.…”

Management Strategies and Outcomes of ST‐Segment Elevation Myocardial Infarction Patients Transferred After Receiving Fibrinolytic Therapy in the United States

“…14 Moreover, real-world data from the French Registry on Acute ST-elevation Myocardial Infarction (FAST-MI), the Global Registry of Acute Coronary Events (GRACE), and the Canadian Registry of Acute Coronary Events (CANRACE) suggested better outcomes with routine angiography and revascularization after fibrinolytic therapy. 15,16 The American College of Cardiology Foundation/American Heart Association STEMI Guidelines also recommend angiography within 3 to 24 hours for patients who have received fibrinolytic therapy as an initial revascularization strategy.…”

“…15,16 A recent study from the Acute Coronary Treatment and Intervention Outcomes Network (ACTION) registry demonstrated that 97.1% of fibrinolytic-treated STEMI patients received coronary angiography after transfer. 17 In our study, 95.5% of patients underwent coronary angiography after being transferred.…”

In-Patient Outcomes of Pharmacoinvasive Reperfusion Strategy for St Elevation Myocardial Infarction

“…ФИС рассматривалась в иссле-дованиях как в контексте определения наиболее подходящей тактики ведения пациентов с ОИМпST после ТТ, которую проводили ввиду невозможности выполнения первичного ЧКВ в рекомендуемые вре-менные рамки по причине различных организацион-ных и логистических проблем (TRANSFER-AMI, CARESS-in-AMI, NORDSTEMI), так и в качестве возможной альтернативы первичному ЧКВ, когда очевидны задержки в проведении инвазивного вме-шательства -например, при переводе из другого стационара (FAST-MI, WEST, GRACIA-2, STREAM). В указанных исследованиях продемонстрировано преимущество раннего рутинного выполнения ЧКВ после ТТ над консервативной "выжидательной" стратегией, а также представлены сопоставимые результаты первичного ЧКВ и максимально быстро начатым тромболизисом с последующим обязатель-ным инвазивным вмешательством [25][26][27][28][29].…”