Nicolas Danchin1,2, Batric Popovic3, Etienne Puymirat1,2, Patrick Goldstein4, Loïc Belle5, Guillaume Cayla6, François Roubille7, Gilles Lemesle8,9,10,11, Jean Ferrières12, François Schiele13, Tabassome Simon14,15,16,17. 1. Department of Cardiology, Hôpital Européen Georges Pompidou, Assistance-Publique Hôpitaux de Paris, 20 rue Leblanc, 75015 Paris, France. 2. Université Paris Descartes, Rue de l'Ecole de Mèdecine, 75006 Paris, France. 3. Department of Cardiology, University Hospital of Nancy, Rue du Morvan, 54500 Vandoeuvre-lès-Nancy, France. 4. Department of Emergency Medicine, University Hospital of Lille, 2 avenue Oscar Lambret, 59000 Lille, France. 5. Department of Cardiology, Centre Hospitalier Annecy Genevois, Annecy, 1 avenue de l'Hôpital, 74370, Epagny Metz-Tessy, France. 6. Department of Cardiology, Centre Hospitalier Universitaire de Nîmes, Université de Montpellier, Place Pr Robert Debré, 30029 Nimes Cedex 09, France. 7. Department of Cardiology, University Hospital of Montpellier, Montpellier, 191 avenue du Doyen Gaston Giraud, 34000, Montpellier, France. 8. USIC et Centre Hémodynamique, Institut Cœur Poumon, Centre Hospitalier Universitaire de Lille, 2 avenue Oscar Lambret, 59000 Lille, France. 9. Faculté de Médecine de l'Université de Lille, 2 avenue Eugène Avinée, 59120 Loos, France. 10. INSERM UMR 1011, Institut Pasteur de Lille, 1 rue Professeur Calmette, 59000 Lille, France. 11. FACT (French Alliance for Cardiovascular Trials), rue Henri Huchard, 75018 Paris, France. 12. Department of Cardiology, Toulouse University Hospital, Toulouse University School of Medicine, INSERM UMR, 1 avenue Professeur Jean Poulhès, 31059 Toulouse, Cedex 9, 1027 Toulouse, France. 13. Hôpital Jean Minjoz, Université de Bourgogne-Franche-Comté, 3 boulevard Alexandre Fleming, 25000 Besançon, France. 14. Deparment of Clinical Pharmacology and Clinical Research Platform of East of Paris (URCEST-CRCEST-CRB), rue de Chaligny, 75012 Paris, France. 15. Assistance Publique-Hôpitaux de Paris, Hôpital St Antoine, rue de Chaligny, 75012 Paris, France. 16. Sorbonne-Université, 91 boulevard de l'Hôpital, 75013 Paris, France. 17. Unité INSERM U-1148, FACT Paris, rue Henri Huchard, 75018 Paris, France.
Abstract
AIMS: ST-segment elevation myocardial infarction (STEMI) guidelines recommend primary percutaneous coronary intervention (pPCI) as the default reperfusion strategy when feasible ≤120 min of diagnostic ECG, and a pharmaco-invasive strategy otherwise. There is, however, a lack of direct evidence to support the guidelines, and in real-world situations, pPCI is often performed beyond recommended timelines. To assess 5-year outcomes according to timing of pPCI (timely vs. late) compared with a pharmaco-invasive strategy (fibrinolysis with referral to PCI centre). METHODS AND RESULTS: The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) programme consists of nationwide observational surveys consecutively recruiting patients admitted for acute myocardial infarction every 5 years. Among the 4250 STEMI patients in the 2005 and 2010 cohorts, those with reperfusion therapy and onset-to-first call time <12 h (n = 2942) were included. Outcomes at 5 years were compared according to type of reperfusion strategy and timing of pPCI, using Cox multivariable analyses and propensity score matching. Among those, 1288 (54%) patients had timely pPCI (≤120 min from ECG), 830 (28%) late pPCI (>120 min), and 824 (28%) intravenous fibrinolysis. Five-year survival was higher with a pharmaco-invasive strategy (89.8%) compared with late pPCI [79.5%; adjusted hazard ratio (HR) 1.51; 1.13-2.02] and similar to timely pPCI (88.2%, adjusted HR 1.02; 0.75-1.38). Concordant results were observed in propensity score-matched cohorts and for event-free survival. CONCLUSION: A substantial proportion of patients have pPCI beyond recommended timelines. As foreseen by the guidelines, these patients have poorer 5-year outcomes, compared with a pharmaco-invasive strategy. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: ST-segment elevation myocardial infarction (STEMI) guidelines recommend primary percutaneous coronary intervention (pPCI) as the default reperfusion strategy when feasible ≤120 min of diagnostic ECG, and a pharmaco-invasive strategy otherwise. There is, however, a lack of direct evidence to support the guidelines, and in real-world situations, pPCI is often performed beyond recommended timelines. To assess 5-year outcomes according to timing of pPCI (timely vs. late) compared with a pharmaco-invasive strategy (fibrinolysis with referral to PCI centre). METHODS AND RESULTS: The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) programme consists of nationwide observational surveys consecutively recruiting patients admitted for acute myocardial infarction every 5 years. Among the 4250 STEMI patients in the 2005 and 2010 cohorts, those with reperfusion therapy and onset-to-first call time <12 h (n = 2942) were included. Outcomes at 5 years were compared according to type of reperfusion strategy and timing of pPCI, using Cox multivariable analyses and propensity score matching. Among those, 1288 (54%) patients had timely pPCI (≤120 min from ECG), 830 (28%) late pPCI (>120 min), and 824 (28%) intravenous fibrinolysis. Five-year survival was higher with a pharmaco-invasive strategy (89.8%) compared with late pPCI [79.5%; adjusted hazard ratio (HR) 1.51; 1.13-2.02] and similar to timely pPCI (88.2%, adjusted HR 1.02; 0.75-1.38). Concordant results were observed in propensity score-matched cohorts and for event-free survival. CONCLUSION: A substantial proportion of patients have pPCI beyond recommended timelines. As foreseen by the guidelines, these patients have poorer 5-year outcomes, compared with a pharmaco-invasive strategy. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Isabel Galeano-Otero; Raquel Del Toro; Agustín Guisado; Ignacio Díaz; Isabel Mayoral-González; Francisco Guerrero-Márquez; Encarnación Gutiérrez-Carretero; Sara Casquero-Domínguez; Luis Díaz-de la Llera; Gonzalo Barón-Esquivias; Manuel Jiménez-Navarro; Tarik Smani; Antonio Ordóñez-Fernández Journal: J Clin Med Date: 2020-04-08 Impact factor: 4.241
Authors: T Kerkman; L B G Ten Brinke; B Huybrechts; R Adams; G Amoroso; R J de Winter; Y Appelman Journal: Neth Heart J Date: 2020-11 Impact factor: 2.380