Sethi R, Mohan L, Vishwakarma P, Singh A, Sharma S, Bhandari M, Shukla A, Sharma A, Chaudhary G, Pradhan A, Chandra S, Narain VS, Dwivedi SK. Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction. World J Cardiol 2023; 15(1): 23-32 [PMID: 36714366 DOI: 10.4330/wjc.v15.i1.23]
Corresponding Author of This Article
Akshyaya Pradhan, MD, Professor, Department of Cardiology, King George's Medical University, Shah Mina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. akshyaya33@gmail.com
Research Domain of This Article
Cardiac & Cardiovascular Systems
Article-Type of This Article
Prospective Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rishi Sethi, Lalit Mohan, Pravesh Vishwakarma, Abhishek Singh, Swati Sharma, Monika Bhandari, Ayush Shukla, Akhil Sharma, Gaurav Chaudhary, Akshyaya Pradhan, Sharad Chandra, Varun Shankar Narain, Sudhanshu Kumar Dwivedi, Department of Cardiology, King George's Medical University, Lucknow 226003, Uttar Pradesh, India
Author contributions: Sethi R and Mohan L conceived the project; Pradhan A, Vishwakarma P, Singh A, and Mohan L were involved in data collection; Shukla A, Bhandari M, Sharma S, and Chaudhary G analyzed the data; Pradhan A and Mohan L performed the literature search; Pradhan A and Sethi R drafted the manuscript; Narain VS, Dwivedi SK, and Chandra S critically reviewed the manuscript; Sethi R, Mohan L and Pradhan A prepared the final manuscript; Sethi R and Pradhan A submitted the initial version; Sethi R, Pradhan A, and Vishwakarma P revised the manuscript; Pradhan A and Vishwakarma P prepared the rebuttal; Pradhan A submitted the revised version.
Institutional review board statement: The study protocol was approved by the local Institutional Review Board and was performed in accordance with Declaration of Helsinki.
Informed consent statement: Written informed consent was received from patient or from patient designees before enrollment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: Data is available with authors and can be made available on request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Akshyaya Pradhan, MD, Professor, Department of Cardiology, King George's Medical University, Shah Mina Road, Chowk, Lucknow 226003, Uttar Pradesh, India. akshyaya33@gmail.com
Received: July 18, 2022 Peer-review started: July 18, 2022 First decision: September 26, 2022 Revised: November 14, 2022 Accepted: December 13, 2022 Article in press: December 13, 2022 Published online: January 26, 2023 Processing time: 177 Days and 21.6 Hours
ARTICLE HIGHLIGHTS
Research background
ST-elevation myocardial infarction (STEMI) when untreated is a potentially fatal condition and timely primary percutaneous coronary intervention (PCI) is the key to improving outcomes.
Research motivation
In developing countries, despite multiple guidelines and interventions, the primary PCI coverage in STEMI remains low in clinical practice. PCI within 24 h of thrombolysis (pharmacoinvasive approach) has emerged as a viable alternative to primary PCI. However, due to logistic and financial reasons, patients in developing world may undergo PCI late (> 24 h) after thrombolysis.
Research objectives
This study aimed to analyze the safety and feasibility of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis. Group 1 (routine) represented those patients undergoing PCI < 24 h of symptom onset and Group 2 (delayed) consisted of those subjects undergoing PCI between 24-72 h of symptom onset.
Research methods
This was a single center, prospective registry at a tertiary care center. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within 30 d of the procedure.
Research results
Among 337 patients with STEMI who underwent thrombolyis, there was no difference in measured clinical outcomes (MACCE) at 30 d between the routine pharmacoinvasive and delayed pharmacoinvasive groups (8.7% vs 12.9%, P = 0.152). The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9 ± 5.3 h and 44.1 ± 14.7 h, respectively.
Research conclusions
Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.
Research perspectives
Late PCI after thromobolysis in STEMI is common in developing world due to logistic and financial reasons. This study demonstrates the safety and feasibility of such delayed pharmacoinvasive PCI, lending credibility to this approach utilized in daily practice.
