Anthony H Gershlick1, Cynthia M Westerhout2, Paul W Armstrong2, Kurt Huber3, Sigrun Halvorsen4, Philippe Gabriel Steg5, Miodrag Ostojic6, Patrick Goldstein7, Antonio C Carvalho8, Frans Van de Werf9, Robert G Wilcox10. 1. University of Leicester, University Hospitals of Leicester Glenfield Hospital, Leicester, UK. 2. Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada. 3. 3rd Department of Medicine, Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria. 4. Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway. 5. Faculté de Médecine Xavier Bichat, Université de Paris XII, Paris, France. 6. University of Leicester, University Hospitals of Leicester Glenfield Hospital, Leicester, UK Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada 3rd Department of Medicine, Cardiology and Emergency Medicine, Wilhelminen hospital, Vienna, Austria Department of Cardiology, Oslo University Hospital Ulleval, Oslo, Norway Faculté de Médecine Xavier Bichat, Université de Paris XII, Paris, France Medical School, University of Belgrade, Belgrade, Serbia the Emergency Department and Service d'aide Medicale Urgente (SAMU), Lille University Hospital, Lille, France Cardiology Division, Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil University Hospital Gasthuisberg, Leuven, Belgium Department of Cardiovascular Medicine, University of Nottingham, Nottingham, UK. 7. Medical School, University of Belgrade, Belgrade, Serbia the Emergency Department and Service d'aide Medicale Urgente (SAMU), Lille University Hospital, Lille, France. 8. Cardiology Division, Department of Medicine, Universidade Federal de São Paulo, São Paulo, Brazil. 9. University Hospital Gasthuisberg, Leuven, Belgium. 10. Department of Cardiovascular Medicine, University of Nottingham, Nottingham, UK.
Abstract
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
RCT Entities:
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. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.
Authors: Suma M Victor; S Vijayakumar; Thomas Alexander; C G Bahuleyan; Arun Srinivas; S Selvamani; S Marutha Priya; K Kamaleswari; Ajit S Mullasari Journal: Indian Heart J Date: 2016-01-12
Authors: Reza Fazel; Timothy I Joseph; Mullasari A Sankardas; Duane S Pinto; Robert W Yeh; Dharam J Kumbhani; Brahmajee K Nallamothu Journal: J Am Heart Assoc Date: 2020-06-05 Impact factor: 5.501