title: Pharmacoinvasive therapy for ST elevation myocardial infarction in China: a pilot study.
abstract: Most patients with acute ST-elevation myocardial infarction (STEMI) cannot receive timely primary percutaneous coronary intervention (PCI) because of lack of facilities or delays in patient transfer or catheterization team mobilization. In these patients, early routine post-thrombolysis PCI might be a reasonable, useful strategy. This study investigated feasibility and safety of early PCI after successful half-dose alteplase reperfusion in a Chinese population. Patients with STEMI received half-dose alteplase if expected time delay to PCI was ≥90 min. Patients who reached clinical criteria of successful thrombolysis reperfusion were recommended to undergo diagnostic angiography within 3-24 h after thrombolysis. Patients with residual stenosis ≥70% in the infarct-related artery underwent PCI, regardless of flow or patency status. Epicardial arterial flow was assessed using thrombolysis in myocardial infarction (TIMI) flow grade and TIMI frame count (CTFC). Myocardial perfusion was assessed using myocardial blush grade (MBG) and TIMI myocardial perfusion frame count (TMPFC). Forty-nine patients were enrolled and underwent diagnostic angiography 3-11.3 h (median 6.5 h) after thrombolysis. Forty-six patients underwent PCI. No procedure-related complications occurred, except two patients who had no reflow after PCI. Twenty-two (47.8%) patients had TIMI grade 3 flow before PCI and 33 (71.7%) after PCI. CTFC was significantly improved after PCI (48.5 ± 32.1 vs. 37.9 ± 25.6, P = 0.01). MBG and TMPFC exhibited a similar improving trend after PCI, and the best myocardial perfusion tended to be achieved 3-12 h after lysis. During the 30-day follow-up, there were two deaths. The composite end point of death, cardiogenic shock, heart failure, reinfarction, and recurrent ischemia occurred in four patients. TIMI minor bleeding occurred in four patients. No TIMI major bleeding and stroke occurred. Early routine PCI after half-dose alteplase thrombolysis in Chinese population appears feasible. A larger clinical trial should be designed to further elucidate its efficacy and safety. Early PCI after thrombolysis in STEMI: The EARLY-PCI pilot feasibility study, ChiCTR-TNC-11001363.
authors.affiliation: Department of Cardiology, Ren Ji Hospital, Shanghai Jiao Tong University School of Medicine, 1630 Dongfang Road, Shanghai 200127, China.
authors.forename: Ling-hong
authors.initials: LH
authors.lastname: Shen
authors.forename: Fang
authors.initials: F
authors.lastname: Wan
authors.forename: Long
authors.initials: L
authors.lastname: Shen
authors.forename: Song
authors.initials: S
authors.lastname: Ding
authors.forename: Xin-rong
authors.initials: XR
authors.lastname: Gong
authors.forename: Zhi-qing
authors.initials: ZQ
authors.lastname: Qiao
authors.forename: Yong-ping
authors.initials: YP
authors.lastname: Du
authors.forename: Wei
authors.initials: W
authors.lastname: Song
authors.forename: Jie-yan
authors.initials: JY
authors.lastname: Shen
authors.forename: Shu-xuan
authors.initials: SX
authors.lastname: Jin
authors.forename: Jun
authors.initials: J
authors.lastname: Pu
authors.forename: Tian-bao
authors.initials: TB
authors.lastname: Yao
authors.forename: Li-sheng
authors.initials: LS
authors.lastname: Jiang
authors.forename: Wei-zhen
authors.initials: WZ
authors.lastname: Li
authors.forename: Guo-wei
authors.initials: GW
authors.lastname: Zhou
authors.forename: Shao-wen
authors.initials: SW
authors.lastname: Liu
authors.forename: Ya-ling
authors.initials: YL
authors.lastname: Han
authors.forename: Ben
authors.initials: B
authors.lastname: He
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D002681:China / Q000453:epidemiology; D005240:Feasibility Studies; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy*; D010865:Pilot Projects; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use
chemical_list: D006493:Heparin; D010959:Tissue Plasminogen Activator
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