Pharmacoinvasive Strategy vs Primary Percutaneous Coronary Intervention in Patients With ST-Elevation Myocardial Infarction: Results From a Study in Mexico City

• Published in: CJC open (Online) 2021-04, Vol.3 (4), p.409-418
• Main Authors: Araiza-Garaygordobil, Diego, Gopar-Nieto, Rodrigo, Cabello-López, Alejandro, Martinez-Amezcua, Pablo, Eid-Lidt, Guering, Baeza-Herrera, Luis A., Gonzalez-Pacheco, Héctor, Briseño-De la Cruz, Jose Luis, Sierra-Lara Martinez, Daniel, Mendoza-García, Salvador, Altamirano-Castillo, Alfredo, Arias-Mendoza, Alexandra
• Format: Article
• Language: English
• Subjects: Original
• ISSN: 2589-790X; 2589-790X
• DOI: 10.1016/j.cjco.2020.11.012

A low proportion of patients with ST-elevation myocardial infarction (STEMI) in low- to middle-income countries receive reperfusion therapy. Although primary percutaneous coronary intervention (PCI) is the method of choice, a pharmacoinvasive strategy (PIs) is reasonable when primary PCI cannot be delivered on a timely basis. The aim of our study was to assess the efficacy and safety of a PIs compared with primary PCI in a real-world setting. This was a prospective registry that included patients with STEMI who received reperfusion during the first 12 hours from symptom onset. The primary composite end point was the occurrence of cardiovascular death, cardiogenic shock, recurrent myocardial infarction, or congestive heart failure at 30 days according to the reperfusion strategy used. The key safety end point was major bleeding (Bleeding Academic Research Consortium [BARC] score 3-5) at 30 days. We included 579 patients with STEMI, 49.7% underwent primary PCI and 50.2% received PIs. Those who received a PIs approach were more likely to present with Killip class > 1 and to have a history of diabetes but were less likely to have a previous cardiovascular disease diagnosis. No statistically significant difference was shown in the primary composite end point according to reperfusion strategy (hazard ratio for PIs, 0.76; 95% confidence interval, 0.48-1.21; P = 0.24). Major bleeding was not different among groups (hazard ratio for PIs, 0.92; 95% confidence interval, 0.45-1.86; P = 0.81). Two patients in the PIs group (0.6%) and no patients in the PCI group had intracranial bleeding (P = 0.15). In this prospective real-world registry, major cardiovascular outcomes and bleeding were not different among patients who underwent a PIs or primary PCI. The study suggests that a PIs is an effective and safe option for patients with STEMI when access to primary PCI is limited. Une faible proportion des patients qui subissent un infarctus du myocarde avec élévation du segment ST (STEMI) dans les pays à revenus faibles/intermédiaires reçoivent un traitement de reperfusion. Même si l’intervention coronarienne percutanée (ICP) primaire constitue la méthode de prédilection, une stratégie pharmaco-invasive  représente une option raisonnable lorsque l’ICP primaire ne peut être réalisée dans un délai acceptable. Cette étude visait à évaluer l’efficacité et l’innocuité d’une stratégie pharmaco-invasive comparativement à une ICP primaire dans la pratique courante. Cette étude consis