Outcomes after pharmacoinvasive strategy versus primary PCI in acute ST elevated myocardial infarction: a retrospective study in Saraburi hospital

Abstract

Introduction: ST segment elevation myocardial infarction (STEMI) is a critical cause of sudden cardiac death. Primary percutaneous intervention (PCI) along with balloon angioplasty is the standard recommendation as the first option for treatment. However, there are many limitations to performing PCI such as the lack of hospital readiness for both equipment and personnel. Therefore, a pharmacoinvasive strategy (PI), which refers to administering streptokinase prior to performing PCI, is an alternative option for treating such conditions.

Objective: To compare the in-hospital mortality rate between patients diagnosed with STEMI who underwent primary PCI and those who received PI treatment

Methodology:  This is a retrospective cohort study that aimed to collect and analyzed data from electronic medical records of patients diagnosed with and treated for STEMI, either through primary PCI or PI, at Saraburi hospital between 1st January 2021 and 31st December 2022. The study was conducted with the approval of the Ethical review board. Statistical analyses were conducted using both descriptive and analytic methods. Cox-proportional hazard analysis was performed to achieve survival information and hazard ratios using STATA software program.  

Results:  A total of 249 patients were included in the study. They were divided into a primary PCI group with 79 patients and a PI group with 170 patients. The in-hospital mortality rate was 8.41% with 11 deaths in the primary PCI group and 10 deaths in the PI group. There was no statistically significant difference in mortality rate between these two treatment groups (adjusted HR 0.75, p = 0.74). The primary PCI group had a significantly lower incidence of major bleeding events than the PI group [1.3% vs 4.7%, respectively (HR 0.01, p = 0.01)]. However, the PI group had a shorter duration of total ischemic time, system delay and reperfusion time compared to the primary PCI group (154 vs 219 minutes, p <0.01; 52 vs 105 minutes, p < 0.01; 37 vs 83 minutes, p < 0.01, respectively). The duration of hospital stay did not differ significantly between the two groups (3.9 vs 3 days, p = 0.21).

Conclusion: Patients diagnosed with STEMI who received PI treatment did not have a significantly different in-hospital mortality rate compared to those who underwent primary PCI. Despite providing a shorter duration of total ischemic time and reperfusion time, PI had a higher risk of major bleeding compared to primary PCI.