Primary percutaneous coronary intervention versus in-hospital thrombolysis as reperfusion therapy in early-arriving low-risk STEMI patients

Yaniv Levi, Aaron Frimerman, Avraham Shotan, Michael Shochat, David S. Blondheim, Amit Segev, Ilan Goldenerg, Mark Kazatsker, Liubov Vasilenko, Nir Shlomo, Simcha R. Meisel

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Trials have shown superiority of primary percutaneous intervention (PPCI) over in-hospital thrombolysis in ST-elevation myocardial infarction (STEMI) patients treated within 12 hours of symptom onset. These studies also included high-risk patients, not all of whom underwent a therapeutic intervention. Objectives: To compare the outcomes of early-arriving stable STEMI patients treated by thrombolysis with or without coronary angiography to the outcomes of PPCI-treated STEMI patients. Methods: Based on six biannual Acute Coronary Syndrome Israeli Surveys comprising 5474 STEMI patients, we analyzed the outcome of 1464 hemodynamically stable STEMI patients treated within 3 hours of onset. Of these, 899 patients underwent PPCI, 383 received in-hospital thrombolysis followed by angiography (TFA), and 182 were treated by thrombolysis only. Results: Median time intervals from symptom onset to admission were similar while door-to-reperfusion intervals were 63, 45 and 52.5 minutes for PPCI, TFA and thrombolysis only, respectively (P < 0.001). The 30-day composite endpoint of death, post-infarction angina and myocardial infarction occurred in 77 patients of the PPCI group (8.6%), 64 treated by TFA (16.7%), and 36 patients of the thrombolysis only group (19.8%, P < 0.001), with differences mostly due to post-infarction angina. One-year mortality rate was 27 (3%), 13 (3.4%) and 11 (6.1%) for PPCI, TFA and thrombolysis-only, respectively (P = 0.12). Conclusions: PPCI was superior to thrombolysis in early-arriving stable STEMI patients with regard to a 30-day composite endpoint driven by a decreased incidence of post-infarction angina. No 1 year survival benefit for PPCI over thrombolysis was observed in early-arriving stable STEMI patients.

Original languageEnglish
Pages (from-to)345-350
Number of pages6
JournalIsrael Medical Association Journal
Volume19
Issue number6
StatePublished - Jun 2017
Externally publishedYes

Keywords

  • Primary percutaneous coronary intervention
  • Reperfusion therapy
  • ST-elevation myocardial infarction (STEMI)
  • Thrombolysis

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