Safety and Efficacy of a Pharmacoinvasive Strategy in ST-Segment Elevation Myocardial Infarction: A Patient Population Study Comparing a Pharmacoinvasive Strategy With a Primary Percutaneous Coronary Intervention Strategy Within a Regional System

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• 作者：Mohammed K. Rashid ; BHSc^a ; ^b ; Nita Guron ; MD^c ; Jordan Bernick ; MSc^a ; George A. Wells ; PhD^b ; Melissa Blondeau ; BSc^a ; Aun-Yeong Chong ; MD^a ; Alexander Dick ; MD^a ; Michael P.V. Froeschl ; MD^a ; Chris A. Glover ; MD^a ; Benjamin Hibbert ; MD^a ; Marino Labinaz ; MD^a ; Jean-Franç ; ois Marquis ; MD^a ; Christina Osborne ; BSc^a ; Derek Y. So ; MD^a ; Michel R. Le May ; MD^a ; ^{mlemay@ottawaheart.ca" class="auth_mail" title="E-mail the corresponding author}
• 关键词：pharmacoinvasive strategy ; primary PCI ; regional STEMI program ; ST-segment elevation myocardial infarction
• 刊名：JACC: Cardiovascular Interventions
• 出版年：2016
• 出版时间：10 October 2016
• 年：2016
• 卷：9
• 期：19
• 页码：2014-2020
• 全文大小：203 K

文摘

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.