Comparison of Efficacy and Outcome of Primary Percutaneous Coronary Intervention to Pharmacoinvasive Strategy in Management of ST-Segment Elevation Myocardial Infarction

Solaiman Hossain^1, , Moeen Uddin Ahmed¹, Md. Shahimur Parvez¹, Debasish Debnath¹, Md. Mahidur Rahman¹, Anup Kumar Das¹ and Tamal Peter¹

¹Department of Cardiology, Enam Medical College and Hospital, Savar, Dhaka, Bangladesh

Cite this paper:
Solaiman Hossain, Moeen Uddin Ahmed, Md. Shahimur Parvez, Debasish Debnath, Md. Mahidur Rahman, Anup Kumar Das and Tamal Peter. Comparison of Efficacy and Outcome of Primary Percutaneous Coronary Intervention to Pharmacoinvasive Strategy in Management of ST-Segment Elevation Myocardial Infarction. American Journal of Medical Sciences and Medicine. 2021; 9(3):64-69. doi: 10.12691/ajmsm-9-3-1

Abstract

Introduction: Primary percutaneous coronary intervention (PPCI) is the best reperfusion option in ST-segment elevation myocardial infarction (STEMI) when performed timely but PPCI is not universally available. Hence, Pharmacoinvasive (PhI) reperfusion strategy is recommended for STEMI patients. However, there are very few studies in Bangladesh for the comparison of efficacy and outcome of PPCI and PhI Strategy. The aim of this study is to compare the efficacy and outcome of PPCI and PhI strategies in patients of Bangladesh. Methodology and Materials: This was a prospective observational comparative study. A total of 783 acute STEMI patients were included in Enam Medical College Hospital, Savar, Dhaka, Bangladesh during December-2015 to April-2019. Among them, 103 patients underwent Primary PCI and 184 patients underwent PhI strategy. Data were collected prospectively using a standardized case report form. Chai-squared tests were done to compare the ratio of the frequency of the groups and t-tests were done to compare the mean of the groups with 95% CI where p<0.05 considered as significant. Results: Among the studied patients, access site complications in PPCI were hematoma, occlusion and pseudo-aneurysm being observed 03(2.91%), 05(4.85) and (0%), whereas, in PhI strategy were 09(4.89%), 08(4.34%), and 02(1.08%) respectively (P>0.05). In hospital, primary composite cardiovascular outcome of death, reinfarction, stroke and CHF were noted insignificant in both the strategies (p>0.05). On follow-up at 01 month, 06 month and 12 month, the composite cardiovascular outcome of death, reinfarction, stroke and CHF) were 03(3.84%), 04(5.12%), and 05(6.41%), in PPCI and 04(2.81%), 09(6.33%), and 07(4.92%) respectively in PhI strategy (P>0.05). Conclusion: Similar clinical, in hospital, and followed up outcomes were found when comparing the efficacy and safety Primary PCI to PhI Strategy in patients with STEMI who were eligible for reperfusion. So, both Primary PCI and Pharmacoinvasive strategies are safe and effective in management of patients with STEMI.

Keywords:
ST-Segment elevation myocardial infarction primary percutaneous coronary intervention pharmacoinvasive strategy

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References:

[1]	McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. “Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI,” Am J Med, 124(1), 40-47, 2011.
[2]	Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. “Population trends in the incidence and outcomes of acute myocardial infarction,” N Engl J Med, 362(23), 2155-2165, 2010.
[3]	Borja Ibanez, Stefan James, Stefan Agewall, et al., “2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC),” European Heart Journal, 39(2), 119-177, 2018.
[4]	Mohammad Zubaid, Wafa A Rashed, Wael Almahmeed, et al., “Management and outcomes of Middle Eastern patients admitted with acute coronary syndromes in the Gulf Registry of Acute Coronary Events (Gulf RACE),” Acta Cardiol, 64(4), 439-446, 2009.
[5]	Gershlick AH, Banning AP, Myat A, Verheugt FW, Gersh BJ. “Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention?” Lancet, 382, 624-632, 2013.
[6]	Lassen JF, Bøtker HE, Terkelsen CJ. “Timely and optimal treatment of patients with STEMI,” Nat Rev Cardiol, 10, 41-48, 2013.
[7]	DS Pinto, Paul D Frederick, Anjan K Chakrabarti, et al., “Benefit of transferring ST-segment-elevation myocardial infarction patients for percutaneous coronary intervention compared with administration of onsite fibrinolytic declines as delays increase,” Circulation, 124(23), 2512-2521, 2011.
[8]	Kurt Huber, Patrick Goldstein, Nicolas Danchin, et al., “Enhancing the efficacy of delivering reperfusion therapy: A European and North American experience with ST-segment elevation myocardial infarction networks”, Am Heart J, 165(2), 123-132, 2013.
[9]	Paul W Armstrong, Anthony H Gershlick, Patrick Goldstein, et al., “Fibrinolysis or primary PCI in ST-segment elevation myocardial Infarction,” N Engl J Med, 368(15), 1379-1387, 2013.
[10]	Duane S Pinto, Ajay J Kirtane, Brahmajee K Nallamothu, et al., Hospital delays in reperfusion for ST-elevation myocardial infarction: Implications when selecting a reperfusion strategy”, Circulation, 114(19), 2019-2025, 2006.
[11]	Ph. Gabriel Steg, Stefan K. James, Dan Atar, et al., “ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC)”, European Heart Journal, 33, 2569-2619, 2012.
[12]	Solhpour A, Yusuf SW, “Fibrinolytic therapy in patients with ST-elevation myocardial infarction”, Expert Rev Cardiovasc Ther, 12(2), 201-15, 2014.
[13]	Armstrong PW, Gershlick AH, Goldstein P, et al., “Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction”, N Engl J Med, 368, 1379-1387, 2013.
[14]	Cannon CP, Brindis RG, Chaitman BR, et al., “2013 ACCF/AHA key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes and coronary artery disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Acute Coronary Syndromes and Coronary Artery Disease Clinical Data Standards)”, Crit Pathw Cardiol, 12(2), 65-105, 2013.
[15]	Zubaid, M., Khraishah, H., Alahmad, B., et al., “Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry”, Annals of Global Health, 86(1), 13.
[16]	Mohammed K Rashid, Nita Guron, Jordan Bernick, et al., “Safety and Efficacy of a Pharmacoinvasive Strategy in ST-Segment Elevation Myocardial Infarction: A Patient Population”, JACC Cardiovasc Interv, 9(19), 2014-2020, 2016.
[17]	Ayman M. Helal, Sameh M. Shaheen, Walid A. Elhammady, Mohamed I. Ahmed, Ahmed S. Abdel-Hakim, and Lamyaa E. Allam. “Primary PCI versus pharmacoinvasive strategy for ST elevation myocardial infarction” Int J Cardiol Heart Vasc, 21, 87-93, 2018.
[18]	M A Brouwer, J S Martin, C Maynard, et al., “Influence of early prehospital thrombolysis on mortality and event-free survival (the Myocardial Infarction Triage and Intervention Randomized Trial)”. Am J Cardiol, 78(5), 497-502, 1996.
[19]	Ahmed Bendary, Wael Tawfek, Mohammed Mahros, Mohamed Salem, “Primary PCI versus Pharmaco-Invasive Strategy in Patients with ST-Elevation Myocardial Infarction; a Randomized Clinical Study” Journal of Cardiovascular Disease Research, 9(1): 28-31, 2018.
[20]	David M Larson, Sue Duval, Scott W Sharkey, et al., “Safety and efficacy of a pharmaco-invasive reperfusion strategy in rural ST-elevation myocardial infarction patients with expected delays due to long-distance transfers”, Eur Heart J, 33(10), 1232-1240, 2012.