Comparison of the Incidence of MACCE in Primary Percutaneous Coronary Intervention vs. Delayed Primary Percutaneous Coronary Intervention 24 hours After Taking Fibrinolytic Therapy in Patients with STEMI OC07-OC10
Farshchian Heart Centre, Fahmide Blvd, 65168, Hamadan, Iran.
Introduction: Annually, over one million Percutaneous Coronary Interventions (PCIs) are performed worldwide. PCI is considered the most common procedure for revascularisation in patients with Coronary Artery Disease (CAD). Primary PCI (PPCI) is recognised as the best available option for the management of patients with ST-Segment Elevation Myocardial Infarction (STEMI). The most important issue about PCI is timing between symptoms’ onset and performing intervention. In non-capable PPCI situations, fibrinolytic therapy alone or followed by angiography and intervention 2-24 hours after it, seems the best alternative choices, but delayed PCI’s results >24 hours were also promising. The Major Adverse Cardiovascular and Cerebrovascular Events (MACCE) include cardiac death, nonfatal myocardial infarction, cerebrovascular events and target vessel revascularisation.
Aim: To compare the occurrence of MACCE after PPCI and PCI >24 hour of successful fibrinolytic drugs.
Materials and Methods: The study was conducted among 457 patients with STEMI, admitted to Farshchian Heart Centre, Hamadan, Iran during 2013-2016. Ninety seven patients were managed with PPCI alone within 90 minutes of symptoms’ onset and 360 patients took Reteplase within 30 minutes followed by PCI >24 hours of successful fibrinolytic therapy and were classified as control and case groups, respectively. Both groups evaluated for MACCE at 3, 6, 12, 24 and 36-month follow-up after PCI. Data analysis was performed with SPSS 18.0. Chi-square test and independent t-test used for analysis. All statistical analyses were carried out at 95% confidence level.
Results: Among 457 patients, 310 (67.8%) were male and 147 (32.2%) were female. There was no statistical significant difference in the occurrence of MACCE, including cardiac death (1% vs. 1.1%; p=0.946), non-fatal myocardial infarction (2.1% vs. 2.5%; p=0.803), target vessel revascularisation (5.6% vs. 8.2%; p=0.327), cerebrovascular complications (2.1% vs. 1.1; p=0.465), and total MACCE (13.4 vs. 10.3; p=0.382) between control group versus case group.
Conclusion: The incidence of MACCE between STEMI patients undergoing PPCI and those managed with fibrinolytic therapy followed by PCI >24 hours later was similar.