Comparison of outcomes and safety of "facilitated" versus primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction.
Recent studies have documented that use of "facilitated" percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) may be harmful. In-hospital outcomes in 1,553 consecutive patients with STEMI without cardiogenic shock who underwent PCI at a single tertiary center within 6 hours of presentation were analyzed. The study group included 767 patients who underwent primary PCI who initially presented to the tertiary center and were triaged for emergent PCI and 786 patients who underwent facilitated PCI who were pretreated at a community hospital with a glycoprotein IIb/IIIa platelet inhibitor and/or intravenous thrombolytic therapy before transfer for catheter-based therapy. Compared with patients who underwent primary PCI, the facilitated PCI group had longer door-to-balloon times (162 +/- 57 vs 113 +/- 61 minutes), higher baseline infarct-vessel TIMI 3 flow rates (52.8% vs 25.4%; p <0.001), and no increase in major adverse in-hospital outcomes. In patients treated with door-to-balloon times >90 and < or =150 minutes, patients who underwent facilitated PCI had fewer composite major adverse clinical events (combined mortality, recurrent myocardial infarction, emergent repeated PCI, hemorrhagic and nonhemorrhagic stroke, and nonintracranial TIMI major bleeding) compared with patients who underwent primary PCI (relative risk 0.50, 95% confidence interval 0.26 to 0.96, p = 0.034). In conclusion, facilitated PCI can be safely used to increase pharmacologic reperfusion before catheter-based therapy in patients with STEMI without an increase in clinical hazard and with fewer major adverse clinical events in patients treated with door-to-balloon times >90 and < or =150 minutes.
McKay
Raymond G
RG
Cardiology Division, Hartford Hospital, Hartford, CT, USA. rmckay@harthosp.org
Dada
Marcin R
MR
Mather
Jeffrey F
JF
Mennet
Roger R
RR
Murphy
Deborah J
DJ
Maloney
Krista W
KW
Hirst
Jeffrey A
JA
Kiernan
Francis J
FJ
D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D004562:Electrocardiography; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors* / Q000627:therapeutic use; D015912:Thrombolytic Therapy / Q000009:adverse effects; D016896:Treatment Outcome
D019039:Platelet Glycoprotein GPIIb-IIIa Complex