Does pharmacoinvasive strategy effectively bridge the gap in the absence of a catherization lab in STEMI patients? Prelimanary results from a single primary Romanian center

Introduction: STEMI is one of the leading causes of death worldwide with a major impact on healthcare resources and expenditure. However, despite primary PCI being the gold standard, it is not always achievable due to a lack of cardiac catheterization services and de-lays in the first medical contact-to-balloon time. Con-sequently, many patients receive thrombolytic therapy at a non-interventional hospital before being transfer-red to a PCI capable hospital.
Objective: T his single centre observational study in-vestigated the efficacy and safety of Pharmacoinvasive Strategy (PIS) versus primary Percutaneous Coronary Intervention (PPCI) for ST–Elevation Myocardial In-farction (STEMI) in the context of the Romanian Nati-onal STEMI program.
Methods: Our hospital provides either primary PCI (PPCI) or pharmacoinvasive strategy once a week, for 24 hours, as per the Romanian National STEMI pro-gram. All confirmed 89 consecutive STEMI patients from January 1st – May 31st 2018 were selected for this study. The primary outcome was in-hospital mortality, while the secondary outcomes were in-hospital Major Adverse Cardiac Events (MACE) and the length of ho-spital stay.
Results: The study was divided into two groups: the first group of 71 patients (61.97% male) received primary PCI while the second group of 18 patients (72.22% male) underwent pharmacoinvasive strategy. The me-dium age was similar-59.45 yo for the first group, and 63.11 yo for the second. Diabetes Mellitus type 2 was more frequent in the first group (32.87%), than in the second group (12.50%), while, family history of CAD was more frequent in the second group (62.50%), than in the first group (6.25%) Moreover, hypercholestero-lemia was also more frequent in the pharmacoinvasive group (50%), than in the first group (37.50%). Arteri-al hypertension was similar in both groups (54.68%, and 50% respectively). The chest pain to wire time was 10.53 hours, and 8.31 hours, in the first and second group respectively. Left ventricular systolic dysfuncti-on (LVEF less than 40%) on arrival was more frequent in the first group (35.48%), than in the second group who underwent thrombolysis before PCI (13.33%). The number of diseased vessels including the culprit lesion vessel were similar (1.56 in the first group, and 1.59 in the second group). The in-hospital mortality was higher in the first group (8.41%), than in the se-cond group (5.55%). The number of in-hospital major adverse cardiac events (MACE) were similar (28.12% in the first group, and 26.66% in the second group). The length of hospital stay was 7.04 days for the PPCI group, and 10.33 days for the pharmacoinvasive group. Conclusions: The outcomes were similar in both phar-macoinvasive strategy and primary PCI. The results suggest that pharmacoinvasive strategy may be an al-ternative for primary PCI in areas where there are no such facilities. Pharmacoinvasive strategy is not used at its potential, yet.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
ESC search engine
CODE: 379
CME Credits: 10 (Romanian College of Physicians)