title: Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in Patients With ST-Segment-Elevation Myocardial Infarction: A Propensity Score-Matched Analysis.
abstract: The Strategic Reperfusion Early After Myocardial Infarction trial and the French Registry of Acute ST-elevation or Non-ST-elevation Myocardial Infarction 2015 suggested that pharmacoinvasive strategy compares favorably with primary percutaneous coronary intervention (PPCI). We sought to assess the clinical impact of pharmacoinvasive strategy compared with PPCI in real-world patients with ST-segment-elevation myocardial infarction.
  
  
  
  We used the Korea Acute Myocardial Infarction Registry to identify ST-segment-elevation myocardial infarction patients receiving either pharmacoinvasive strategy defined as fibrinolysis followed by percutaneous coronary intervention (rescue/urgent or routine elective; n=708) or PPCI (n=8878). Patients receiving facilitated percutaneous coronary intervention within 3 hours from fibrinolysis were excluded. Propensity-matched 12-month clinical outcome was compared. In the propensity-matched cohort (n=706 in each group), the pharmacoinvasive group had shorter time to reperfusion therapy (165 versus 241 minutes; P<0.001) and higher rate of pre-percutaneous coronary intervention Thrombolysis in Myocardial Infarction grade 3 (50.4% versus 13.7%; P<0.001). Incidences of major bleeding and stroke during hospitalization were not different. Twelve-month rates of death and major adverse cardiac events (composite of death, recurrent myocardial infarction, target-vessel revascularization, and coronary artery bypass graft surgery) were similar between pharmacoinvasive strategy and PPCI: 4.4% versus 4.1% and 7.5% versus 7.8%, respectively. Equipoise between pharmacoinvasive strategy and PPCI for 12-month major adverse cardiac events occurred when percutaneous coronary intervention-related delay was ≈100 minutes.
  
  
  
  ST-segment-elevation myocardial infarction patients receiving pharmacoinvasive treatment, compared with PPCI, had shorter time to reperfusion, higher culprit-vessel patency, and similar 12-month clinical outcome.
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Doo Sun
authors: DS
authors: Sim
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.). myungho@chollian.net.
authors: Myung Ho
authors: MH
authors: Jeong
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Youngkeun
authors: Y
authors: Ahn
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Young Jo
authors: YJ
authors: Kim
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Shung Chull
authors: SC
authors: Chae
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Taek Jong
authors: TJ
authors: Hong
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: In Whan
authors: IW
authors: Seong
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Jei Keon
authors: JK
authors: Chae
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Chong Jin
authors: CJ
authors: Kim
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Myeong Chan
authors: MC
authors: Cho
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Seung-Woon
authors: SW
authors: Rha
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Jang Ho
authors: JH
authors: Bae
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Ki Bae
authors: KB
authors: Seung
authors: From the Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea (D.S.S., M.H.J., Y.A.); Division of Cardiology, Yeungnam University Hospital, Daegu, Republic of Korea (Y.J.K.); Division of Cardiology, Kyungpuk National University Hospital, Daegu, Republic of Korea (S.C.C.); Department of Cardiology, Busan National University Hospital, Republic of Korea (T.J.H.); Department of Cardiology, Chungnam National University Hospital, Daejon, Republic of Korea (I.W.S.); Department of Cardiology, Chunbuk National University Hospital, Jeonju, Republic of Korea (J.K.C.); Department of Cardiovascular Medicine, Kyung Hee University Hospital, Seoul, Republic of Korea (C.J.K.); Department of Cardiology, Chungbuk National University Hospital, Cheongju, Republic of Korea (M.C.C.); Department of Cardiology, Korea University Guro Hospital, Seoul (S.-W.R.); Division of Cardiology, Konyang University Hospital, Daejon, Republic of Korea (J.H.B.); Division of Cardiology, Catholic University Hospital, Seoul, Republic of Korea (K.B.S.); and Department of Cardiology, Asan Medical Center, Seoul, Republic of Korea (S.J.P.).
authors: Seung Jung
authors: SJ
authors: Park
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D006470:Hemorrhage / Q000139:chemically induced; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012008:Recurrence; D012042:Registries; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D020521:Stroke / Q000209:etiology; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D061665:Time-to-Treatment; D016896:Treatment Outcome; D014654:Vascular Patency
chemical_list: D005343:Fibrinolytic Agents
keywords: coronary artery bypass; fibrinolysis; myocardial infarction; percutaneous coronary intervention; stroke