Post-streptokinase PCI in STEMI patients exceeding the 24-h guidelines

Abstract

Background Due to delay in obtaining approval from insurance institution, performing PCI after successful reperfusion using streptokinase was postponed for ˃24 h-1 week. The study was conducted to investigate safety and efficacy of such delay in comparison to the ideal guidelines of PCI (≤ 24 h) in 129 STEMI patients received streptokinase followed by PCI. Patients were divided into two groups: (group 1 = 57; early PCI ≤ 24 h.) and (group 2 = 72; late PCI > 24 h.). Results Primary end point was death, congestive heart failure and reinfarction up to 30 days. Secondary end point was TIMI flow < G3, ischemic stroke, intracranial hemorrhage and non-intracranial bleeding. No statistical significant difference was found between both groups regarding LVEF, dimensions and myocardium wall preservation and incidence of complications and TIMI flow. No primary endpoints were detected. Five patients had secondary endpoints in early PCI and four in the late PCI. Suction device and IV Eptifibatide were used more in early PCI (p = 0.003). Conclusions The study suggests that relatively late PCI (> 24 h–1wk) after successful reperfusion using streptokinase in STEMI patients seems to be safe and effective in 30-day follow-up, provided that patients received DAPT and were subjected to close observation. The results seem safely applicable when we are forced to this choice; however lack of more investigations to this hypothesis is considered a limitation.

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

“…Post-streptokinase PCI in STEMI patients exceeding the 24-h guidelines. (2021) (9) Estudio observacional. Pacientes fibrinolizados con éxito con estreptoquinasa.…”

“…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) .…”