Published online Jan 26, 2023. doi: 10.4330/wjc.v15.i1.23
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
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.
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.
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.
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.
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.
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.
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.