OBJECTIVES: 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. BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVES: 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. BACKGROUND: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.
Authors: Sameer Mehta; Christopher B Granger; Timothy D Henry; Cindy Lee Grines; Alexandra Lansky; Ivan Rokos; Roberto Botelho; Andreas Baumbach; Sundeep Mishra; Tan Huay Cheem; Damras Tresukosol; Robaayah Zambahari; Alexandra Ferré; Marco Castillo Journal: Indian Heart J Date: 2017-01-10
Authors: Himawan Fernando; Diem Dinh; Stephen J Duffy; Angela Brennan; Anand Sharma; David Clark; Andrew Ajani; Melanie Freeman; Karlheinz Peter; Dion Stub; Chin Hiew; Christopher M Reid; Ernesto Oqueli Journal: Int J Cardiol Heart Vasc Date: 2021-03-15
Authors: Deep Chandh Raja; Vijayakumar Subban; Suma M Victor; George Joseph; Viji Samuel Thomson; Kumaresan Kannan; Justin Paul Gnanaraj; Ganesh Veerasekar; Jose G Thenpally; Nandhini Livingston; Brahmajee K Nallamothu; Thomas Alexander; Ajit S Mullasari Journal: Indian Heart J Date: 2017-07-18
Authors: Haitham Khraishah; Barrak Alahmad; Eric Secemsky; Michael N Young; Ahmed ElGuindy; Mark J Siedner; Mohamad Kassab; Dhaval Kholte; Khuzeima Khanbhai; Mohamed Janabi; Kevin Kennedy; Mazen S Albaghdadi Journal: Glob Heart Date: 2020-10-12