Safety and Efficacy of a Pharmacoinvasive Strategy in ST-Segment Elevation Myocardial Infarction: A Patient Population Study Comparing a Pharmacoinvasive Strategy With a Primary Percutaneous Coronary Intervention Strategy Within a Regional System
| Autor: | Mohammed K, Rashid, Nita, Guron, Jordan, Bernick, George A, Wells, Melissa, Blondeau, Aun-Yeong, Chong, Alexander, Dick, Michael P V, Froeschl, Chris A, Glover, Benjamin, Hibbert, Marino, Labinaz, Jean-François, Marquis, Christina, Osborne, Derek Y, So, Michel R, Le May |
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| Rok vydání: | 2016 |
| Předmět: |
Male
Time Factors Hemorrhage Regional Health Planning Time-to-Treatment Percutaneous Coronary Intervention Catchment Area Health Fibrinolytic Agents Recurrence Risk Factors Odds Ratio Humans Thrombolytic Therapy Registries Aged Retrospective Studies Ontario Chi-Square Distribution Anticoagulants Middle Aged Stroke Logistic Models Treatment Outcome Editorial Tissue Plasminogen Activator Multivariate Analysis Tenecteplase ST Elevation Myocardial Infarction Female Delivery of Health Care Platelet Aggregation Inhibitors |
| Zdroj: | JACC. Cardiovascular interventions. 9(19) |
| ISSN: | 1876-7605 |
| Popis: | This study investigated the safety and efficacy of a pharmacoinvasive strategy compared with a primary percutaneous coronary intervention (PCI) strategy for ST-segment elevation myocardial infarction (STEMI) in the context of a real-world system.Primary PCI continues to be the optimal reperfusion therapy; however, in areas where PCI centers are not readily available, a pharmacoinvasive strategy has been proposed.The University of Ottawa Heart Institute regional STEMI system provides a primary PCI strategy for patients presenting within a 90-km radius from the PCI center, and a pharmacoinvasive strategy for patients outside this limit. We included all confirmed STEMI patients between April 2009 and May 2011. The primary efficacy outcome was a composite of mortality, reinfarction, or stroke and the primary safety outcome was major bleeding.We identified 236 and 980 consecutive patients enrolled in pharmacoinvasive and primary PCI strategies, respectively. The median door-to-needle time was 31 min in the pharmacoinvasive group and the median door-to-balloon time was 95 min in the primary PCI group. In a multivariable model, there was no significant difference in the primary efficacy outcome (odds ratio: 1.54; p = 0.21); however, the propensity for more bleeding with a pharmacoinvasive strategy approached statistical significance (odds ratio: 2.02; p = 0.08).Within the context of a STEMI system, a pharmacoinvasive strategy was associated with similar rates of the composite of mortality, reinfarction, or stroke as compared with a primary PCI strategy; however, there was a propensity for more bleeding with a pharmacoinvasive strategy. |
| Databáze: | OpenAIRE |
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