Impact of a pharmacoinvasive strategy when delays to primary PCI are prolonged
| Autor: | Antonio Carlos Carvalho, Frans Van de Werf, Robert G. Wilcox, Miodrag Ostojic, Kurt Huber, Patrick Goldstein, Philippe Gabriel Steg, Paul W. Armstrong, Cynthia M. Westerhout, Sigrun Halvorsen, Anthony H. Gershlick |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty medicine.medical_treatment Myocardial Infarction Myocardial Reperfusion Time-to-Treatment law.invention Percutaneous Coronary Intervention Fibrinolytic Agents Randomized controlled trial Recurrence law Internal medicine medicine Humans Prospective Studies Myocardial infarction Prospective cohort study Aged Interventional cardiology business.industry Cardiogenic shock Percutaneous coronary intervention Middle Aged medicine.disease 3. Good health Treatment Outcome Heart failure Conventional PCI Cardiology Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | Heart. 101:692-698 |
| ISSN: | 1468-201X 1355-6037 |
| Popis: | Objectives Primary percutaneous coronary intervention (P-PCI) is the preferred reperfusion option in ST-elevation myocardial infarction, but its benefits become attenuated as time to its potential delivery becomes prolonged. Based on the STrategic Reperfusion Early After Myocardial Infarction trial, we assessed the impact of increasing time delay on outcomes in patients randomised to a pharmacoinvasive strategy (PI) or P-PCI. Methods Thirty-day clinical outcomes were examined according to PCI-related delay (P-RD). Data from hospitals that enrolled >10 randomised patients were used and P-RD categorised as ≤55 min, >55–97 min and >97 min. Results Composite of death/congestive heart failure/cardiogenic shock/myocardial infarction in PI and P-PCI arms occurred in 10.6% versus 10.3% (≤55 min, p=0.910); 13.9% versus 17.9% (>55–97 min, p=0.148) and 13.5% versus 16.2% (>97 min, p=0.470), respectively. While there was no worsening of outcomes for PI across the P-RD spectrum, this occurred in the P-PCI arm (p(trend)=0.038). For P-RD ≤55 min, fewer events tended to occur with P-PCI than PI. Conversely, as P-RD increased to >55 min, PI-assigned patients had better outcomes than P-PCI, suggesting an event-free advantage with PI as P-RD increased (p(interaction)=0.094). Analysing P-RD continuously showed that for every 10-min increment there was an increasing trend towards benefit among PI-assigned patients (p(interaction)=0.073). Conclusions As P-RD increased, PI outcomes became superior to P-PCI when P-RD is prolonged and exceeds guideline-mandated times. In such circumstances, a PI strategy may provide an alternative reperfusion option. Adverse time delays for delivery of P-PCI should be considered when evaluating reperfusion strategies. Trial registration number NCT00623623. |
| Databáze: | OpenAIRE |
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