Two-year follow-up data from the STEPP-AMI study: A prospective, observational, multicenter study comparing tenecteplase-facilitated PCI versus primary PCI in Indian patients with STEMI.

Autor:	Victor SM; Consultant Cardiologist, Madras Medical Mission, Chennai, India. Electronic address: sumavictor@yahoo.com., Vijayakumar S; Senior Consultant Cardiologist, Madras Medical Mission, Chennai, India., Alexander T; Consultant Cardiologist, Kovai Medical Center and Hospital, Coimbatore, India., Bahuleyan CG; Chairman, Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India., Srinivas A; Head of the Department, Cardiology, Vikram Group of Hospitals, Mysore, India., Selvamani S; Senior Consultant Cardiologist, Meenakshi Mission Hospital and Research Centre, Madurai, India., Priya SM; Senior CRA, Madras Medical Mission, Chennai, India., Kamaleswari K; Clinical Trial Manager, Madras Medical Mission, Chennai, India., Mullasari AS; Senior Consultant Cardiologist, Madras Medical Mission, Chennai, India; Director of Cardiology, Madras Medical Mission, Chennai, India.
Jazyk:	angličtina
Zdroj:	Indian heart journal [Indian Heart J] 2016 Mar-Apr; Vol. 68 (2), pp. 169-73. Date of Electronic Publication: 2016 Jan 12.
DOI:	10.1016/j.ihj.2015.08.027
Abstrakt:	Background: A pharmacoinvasive strategy may alleviate the logistical and geographical barriers in timely reperfusion of ST-segment elevation myocardial infarction (STEMI), especially in a developing country like India. Aim: To assess the safety and efficacy of pharmacoinvasive strategy versus primary PCI in STEMI patients at 2 years. Methods: Patients enrolled in STEPP-AMI, an observational, multicenter, prospective study of 200 patients presenting with STEMI, were followed up for 2 years. Group 'A' comprised of patients with pharmacoinvasive strategy (n=45), and patients who underwent primary PCI (n=155) formed group 'B'. Primary endpoint was composite of death, cardiogenic shock, reinfarction, repeat revascularization of the culprit artery, or congestive heart failure at 30 days, with follow-up till 2 years. Results: The primary endpoint occurred in 11.1% and 17.8% in group A and in 3.9% and 13.6% in group B, at 30 days and 2 years, respectively (p=0.07, RR=2.87; 95% CI: 0.92-8.97 at 30 days and p=0.47, RR=1.31; 95% CI: 0.62-2.76). There was no difference in bleeding risk between groups, 2.2% in group A and 0.6% in group B ('p'=0.4). The infarct-related artery patency varied at angiogram; it was 82.2% in arm A and 22.6% in arm B ('p'<0.001). In group A, failed fibrinolysis occurred in 12.1%. Conclusion: A pharmacoinvasive strategy resulted in outcomes that were comparable with primary PCI at 2 years, suggesting it might be a viable option in India. Larger studies are required to confirm these findings. (Copyright © 2015 Cardiological Society of India. Published by Elsevier B.V. All rights reserved.)
Databáze:	MEDLINE
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