One-week and 6-month cardiovascular magnetic resonance outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction.
OBJECTIVE
Pharmacoinvasive strategy represents an attractive alternative to primary angioplasty. Using cardiovascular magnetic resonance imaging we compared the left ventricular outcome of the pharmacoinvasive strategy and primary angioplasty for the reperfusion of ST-segment elevation myocardial infarction.


METHODS
Cardiovascular magnetic resonance was performed 1 week and 6 months after infarction in two consecutive cohorts of patients included in a prospective university hospital ST-segment elevation myocardial infarction registry. During the period 2004-2006, 151 patients were treated with pharmacoinvasive strategy (thrombolysis followed by routine non-immediate angioplasty). During the period 2007-2008, 93 patients were treated with primary angioplasty. A propensity score matched population was also evaluated.


RESULTS
At 1-week cardiovascular magnetic resonance, pharmacoinvasive strategy and primary angioplasty patients showed a similar extent of area at risk (29±15 vs. 29±17%, P=.9). Non-significant differences were detected by cardiovascular magnetic resonance at 1 week and at 6 months in infarct size, salvaged myocardium, microvascular obstruction, ejection fraction, end-diastolic volume index and end-systolic volume index (P>.2 in all cases). The same trend was observed in 1-to-1 propensity score matched patients. The rate of major adverse cardiac events (death and/or re-infarction) at 1 year was 6% in pharmacoinvasive strategy and 7% in primary angioplasty patients (P=.7).


CONCLUSIONS
A pharmacoinvasive strategy including thrombolysis and routine non-immediate angioplasty represents a widely available and logistically attractive approach that yields identical short-term and long-term cardiovascular magnetic resonance-derived left ventricular outcome compared to primary angioplasty.
Departamento de Cardiología, Hospital Clínico Universitario, INCLIVA, Universidad de Valencia, Valencia, España. vicentbodi@hotmail.com
Vicente
V
Bodí
Eva
E
Rumiz
Pilar
P
Merlos
Julio
J
Nunez
Maria P
MP
López-Lereu
José V
JV
Monmeneu
Fabián
F
Chaustre
David
D
Moratal
Isabel
I
Trapero
Maria L
ML
Blasco
Ricardo
R
Oltra
Rafael
R
Sanjuán
Francisco J
FJ
Chorro
Angel
A
Llàcer
Juan
J
Sanchis
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D006328:Cardiac Catheterization; D023381:Endpoint Determination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000379:methods*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000473:pathology / Q000628:therapy*; D015428:Myocardial Reperfusion Injury / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D015424:Reperfusion / Q000379:methods; D015912:Thrombolytic Therapy; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology