Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in Patients with ST-Segment-Elevation Myocardial Infarction: A Propensity Score-Matched Analysis

Doo Sun Sim, Myung Ho Jeong, Youngkeun Ahn, Young Jo Kim, Shung Chull Chae, Taek Jong Hong, In Whan Seong, Jei Keon Chae, Chong Jin Kim, Myeong Chan Cho, Seung-Woon Rha, Jang Ho Bae, Ki Bae Seung, Seung Jung Park

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background-The Strategic Reperfusion Early After Myocardial Infarction trial and the French Registry of Acute ST-elevation or Non-ST-elevation Myocardial Infarction 2015 suggested that pharmacoinvasive strategy compares favorably with primary percutaneous coronary intervention (PPCI). We sought to assess the clinical impact of pharmacoinvasive strategy compared with PPCI in real-world patients with ST-segment-elevation myocardial infarction. Methods and Results-We used the Korea Acute Myocardial Infarction Registry to identify ST-segment-elevation myocardial infarction patients receiving either pharmacoinvasive strategy defined as fibrinolysis followed by percutaneous coronary intervention (rescue/urgent or routine elective; n=708) or PPCI (n=8878). Patients receiving facilitated percutaneous coronary intervention within 3 hours from fibrinolysis were excluded. Propensity-matched 12-month clinical outcome was compared. In the propensity-matched cohort (n=706 in each group), the pharmacoinvasive group had shorter time to reperfusion therapy (165 versus 241 minutes; P<0.001) and higher rate of pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 3 (50.4% versus 13.7%; P<0.001). Incidences of major bleeding and stroke during hospitalization were not different. Twelve-month rates of death and major adverse cardiac events (composite of death, recurrent myocardial infarction, target-vessel revascularization, and coronary artery bypass graft surgery) were similar between pharmacoinvasive strategy and PPCI: 4.4% versus 4.1% and 7.5% versus 7.8%, respectively. Equipoise between pharmacoinvasive strategy and PPCI for 12-month major adverse cardiac events occurred when percutaneous coronary intervention-related delay was ≈100 minutes. Conclusions-ST-segment-elevation myocardial infarction patients receiving pharmacoinvasive treatment, compared with PPCI, had shorter time to reperfusion, higher culprit-vessel patency, and similar 12-month clinical outcome.

Original languageEnglish
Article numbere003508
JournalCirculation: Cardiovascular Interventions
Volume9
Issue number9
DOIs
Publication statusPublished - 2016 Sep 1

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Propensity Score
Percutaneous Coronary Intervention
Myocardial Infarction
Reperfusion
Fibrinolysis
Registries
ST Elevation Myocardial Infarction
Korea
Coronary Artery Bypass
Hospitalization
Stroke
Hemorrhage
Transplants

Keywords

  • Coronary artery bypass
  • fibrinolysis
  • myocardial infarction
  • percutaneous coronary intervention
  • stroke

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in Patients with ST-Segment-Elevation Myocardial Infarction : A Propensity Score-Matched Analysis. / Sim, Doo Sun; Jeong, Myung Ho; Ahn, Youngkeun; Kim, Young Jo; Chae, Shung Chull; Hong, Taek Jong; Seong, In Whan; Chae, Jei Keon; Kim, Chong Jin; Cho, Myeong Chan; Rha, Seung-Woon; Bae, Jang Ho; Seung, Ki Bae; Park, Seung Jung.

In: Circulation: Cardiovascular Interventions, Vol. 9, No. 9, e003508, 01.09.2016.

Research output: Contribution to journalArticle

Sim, Doo Sun ; Jeong, Myung Ho ; Ahn, Youngkeun ; Kim, Young Jo ; Chae, Shung Chull ; Hong, Taek Jong ; Seong, In Whan ; Chae, Jei Keon ; Kim, Chong Jin ; Cho, Myeong Chan ; Rha, Seung-Woon ; Bae, Jang Ho ; Seung, Ki Bae ; Park, Seung Jung. / Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in Patients with ST-Segment-Elevation Myocardial Infarction : A Propensity Score-Matched Analysis. In: Circulation: Cardiovascular Interventions. 2016 ; Vol. 9, No. 9.
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abstract = "Background-The Strategic Reperfusion Early After Myocardial Infarction trial and the French Registry of Acute ST-elevation or Non-ST-elevation Myocardial Infarction 2015 suggested that pharmacoinvasive strategy compares favorably with primary percutaneous coronary intervention (PPCI). We sought to assess the clinical impact of pharmacoinvasive strategy compared with PPCI in real-world patients with ST-segment-elevation myocardial infarction. Methods and Results-We used the Korea Acute Myocardial Infarction Registry to identify ST-segment-elevation myocardial infarction patients receiving either pharmacoinvasive strategy defined as fibrinolysis followed by percutaneous coronary intervention (rescue/urgent or routine elective; n=708) or PPCI (n=8878). Patients receiving facilitated percutaneous coronary intervention within 3 hours from fibrinolysis were excluded. Propensity-matched 12-month clinical outcome was compared. In the propensity-matched cohort (n=706 in each group), the pharmacoinvasive group had shorter time to reperfusion therapy (165 versus 241 minutes; P<0.001) and higher rate of pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 3 (50.4{\%} versus 13.7{\%}; P<0.001). Incidences of major bleeding and stroke during hospitalization were not different. Twelve-month rates of death and major adverse cardiac events (composite of death, recurrent myocardial infarction, target-vessel revascularization, and coronary artery bypass graft surgery) were similar between pharmacoinvasive strategy and PPCI: 4.4{\%} versus 4.1{\%} and 7.5{\%} versus 7.8{\%}, respectively. Equipoise between pharmacoinvasive strategy and PPCI for 12-month major adverse cardiac events occurred when percutaneous coronary intervention-related delay was ≈100 minutes. Conclusions-ST-segment-elevation myocardial infarction patients receiving pharmacoinvasive treatment, compared with PPCI, had shorter time to reperfusion, higher culprit-vessel patency, and similar 12-month clinical outcome.",
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AU - Jeong, Myung Ho

AU - Ahn, Youngkeun

AU - Kim, Young Jo

AU - Chae, Shung Chull

AU - Hong, Taek Jong

AU - Seong, In Whan

AU - Chae, Jei Keon

AU - Kim, Chong Jin

AU - Cho, Myeong Chan

AU - Rha, Seung-Woon

AU - Bae, Jang Ho

AU - Seung, Ki Bae

AU - Park, Seung Jung

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N2 - Background-The Strategic Reperfusion Early After Myocardial Infarction trial and the French Registry of Acute ST-elevation or Non-ST-elevation Myocardial Infarction 2015 suggested that pharmacoinvasive strategy compares favorably with primary percutaneous coronary intervention (PPCI). We sought to assess the clinical impact of pharmacoinvasive strategy compared with PPCI in real-world patients with ST-segment-elevation myocardial infarction. Methods and Results-We used the Korea Acute Myocardial Infarction Registry to identify ST-segment-elevation myocardial infarction patients receiving either pharmacoinvasive strategy defined as fibrinolysis followed by percutaneous coronary intervention (rescue/urgent or routine elective; n=708) or PPCI (n=8878). Patients receiving facilitated percutaneous coronary intervention within 3 hours from fibrinolysis were excluded. Propensity-matched 12-month clinical outcome was compared. In the propensity-matched cohort (n=706 in each group), the pharmacoinvasive group had shorter time to reperfusion therapy (165 versus 241 minutes; P<0.001) and higher rate of pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 3 (50.4% versus 13.7%; P<0.001). Incidences of major bleeding and stroke during hospitalization were not different. Twelve-month rates of death and major adverse cardiac events (composite of death, recurrent myocardial infarction, target-vessel revascularization, and coronary artery bypass graft surgery) were similar between pharmacoinvasive strategy and PPCI: 4.4% versus 4.1% and 7.5% versus 7.8%, respectively. Equipoise between pharmacoinvasive strategy and PPCI for 12-month major adverse cardiac events occurred when percutaneous coronary intervention-related delay was ≈100 minutes. Conclusions-ST-segment-elevation myocardial infarction patients receiving pharmacoinvasive treatment, compared with PPCI, had shorter time to reperfusion, higher culprit-vessel patency, and similar 12-month clinical outcome.

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KW - Coronary artery bypass

KW - fibrinolysis

KW - myocardial infarction

KW - percutaneous coronary intervention

KW - stroke

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