title: Two-year follow-up data from the STEPP-AMI study: A prospective, observational, multicenter study comparing tenecteplase-facilitated PCI versus primary PCI in Indian patients with STEMI.
abstract: BACKGROUND
  A pharmacoinvasive strategy may alleviate the logistical and geographical barriers in timely reperfusion of ST-segment elevation myocardial infarction (STEMI), especially in a developing country like India.
  
  
  OBJECTIVE
  To assess the safety and efficacy of pharmacoinvasive strategy versus primary PCI in STEMI patients at 2 years.
  
  
  METHODS
  Patients enrolled in STEPP-AMI, an observational, multicenter, prospective study of 200 patients presenting with STEMI, were followed up for 2 years. Group 'A' comprised of patients with pharmacoinvasive strategy (n=45), and patients who underwent primary PCI (n=155) formed group 'B'. Primary endpoint was composite of death, cardiogenic shock, reinfarction, repeat revascularization of the culprit artery, or congestive heart failure at 30 days, with follow-up till 2 years.
  
  
  RESULTS
  The primary endpoint occurred in 11.1% and 17.8% in group A and in 3.9% and 13.6% in group B, at 30 days and 2 years, respectively (p=0.07, RR=2.87; 95% CI: 0.92-8.97 at 30 days and p=0.47, RR=1.31; 95% CI: 0.62-2.76). There was no difference in bleeding risk between groups, 2.2% in group A and 0.6% in group B ('p'=0.4). The infarct-related artery patency varied at angiogram; it was 82.2% in arm A and 22.6% in arm B ('p'<0.001). In group A, failed fibrinolysis occurred in 12.1%.
  
  
  CONCLUSIONS
  A pharmacoinvasive strategy resulted in outcomes that were comparable with primary PCI at 2 years, suggesting it might be a viable option in India. Larger studies are required to confirm these findings.
authors.affiliation: Consultant Cardiologist, Madras Medical Mission, Chennai, India. Electronic address: sumavictor@yahoo.com.
authors.forename: Suma M
authors.initials: SM
authors.lastname: Victor
authors.affiliation: Senior Consultant Cardiologist, Madras Medical Mission, Chennai, India.
authors.forename: S
authors.initials: S
authors.lastname: Vijayakumar
authors.affiliation: Consultant Cardiologist, Kovai Medical Center and Hospital, Coimbatore, India.
authors.forename: Thomas
authors.initials: T
authors.lastname: Alexander
authors.affiliation: Chairman, Cardiovascular Centre, Ananthapuri Hospitals and Research Institute, Trivandrum, Kerala, India.
authors.forename: C G
authors.initials: CG
authors.lastname: Bahuleyan
authors.affiliation: Head of the Department, Cardiology, Vikram Group of Hospitals, Mysore, India.
authors.forename: Arun
authors.initials: A
authors.lastname: Srinivas
authors.affiliation: Senior Consultant Cardiologist, Meenakshi Mission Hospital and Research Centre, Madurai, India.
authors.forename: S
authors.initials: S
authors.lastname: Selvamani
authors.affiliation: Senior CRA, Madras Medical Mission, Chennai, India.
authors.forename: S Marutha
authors.initials: SM
authors.lastname: Priya
authors.affiliation: Clinical Trial Manager, Madras Medical Mission, Chennai, India.
authors.forename: K
authors.initials: K
authors.lastname: Kamaleswari
authors.affiliation: Senior Consultant Cardiologist, Madras Medical Mission, Chennai, India; Director of Cardiology, Madras Medical Mission, Chennai, India.
authors.forename: Ajit S
authors.initials: AS
authors.lastname: Mullasari
mesh_terms: D004562:Electrocardiography; D005240:Feasibility Studies; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007194:India / Q000453:epidemiology; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D010865:Pilot Projects; D011446:Prospective Studies; D012008:Recurrence; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D000077785:Tenecteplase; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase
keywords: Pharmacoinvasive strategy; ST elevation myocardial infarction; Timely reperfusion