Lower mortality rates seen with pharmaco-invasive strategy than late primary PCI in STEMI patients

The study featured in the European Heart Journal found that patients who underwent late pPCI (>120 min from first medical contact) had higher mortality rates than those undergoing a pharmaco-invasive strategy. Also, long-term bleeding, myocardial infarction, and stroke rates were comparable among the groups.

Pharmaco-invasive PCI (PI-PCI) is recommended for ST-elevation myocardial infarction (STEMI) patients who cannot undergo primary PCI. John Kerswell French, School of Medicine, Western Sydney University, Gilchrist Drive, Sydney, Australia, and colleagues examined late outcomes after PI-PCI (successful reperfusion followed by scheduled PCI or failed reperfusion and rescue PCI) versus timely and late pPCI.

The study included all STEMI patients presenting within 12 h of symptom onset who underwent PCI during their initial hospitalization at Liverpool Hospital in Sydney. Amongst 2091 STEMI patients, 80% were made, 52% underwent pPCI (68% timely, 32% late), and 48% received PI-PCI (67% scheduled, 33% rescue).

The authors reported the following findings:

• Mortality at three years was 11.1% after pPCI (6.7% timely, 20.2% late) and 6.2% after PI-PCI (9.4% rescue, 4.8% scheduled).
• After propensity matching, the adjusted mortality hazard ratio (HR) for timely pPCI compared with scheduled PCI was 0.9 and compared with rescue PCI; it was 0.5.
• The adjusted mortality HR for late pPCI, compared with scheduled PCI, was 2.2; compared with rescue PCI, it was 1.5.

"Patients who underwent primary PCI had greater mortality rates than those undergoing a pharmaco-invasive strategy," the researchers wrote. "A pharmaco-invasive approach should be considered in cases where delays to PCI are anticipated despite rescue PCI being required in a third of patients, as it gives better outcomes than late primary PCI."

Reference:

Javeria Jamal, Hanan Idris, Amir Faour, Wesley Yang, Alison McLean, Sonya Burgess, Ibrahim Shugman, Kathryn Wales, Aiden O'Loughlin, Dominic Leung, Christian Julian Mussap, Craig Phillip Juergens, Sidney Lo, John Kerswell French, Late outcomes of ST-elevation myocardial infarction treated by pharmaco-invasive or primary percutaneous coronary intervention, European Heart Journal, 2022;, ehac661, https://doi.org/10.1093/eurheartj/ehac661