International Journal of Biomedicine. 2018;8(1):9-14.
Originally published March 15, 2018
The aim of this study was to evaluate in-hospital outcomes of percutaneous coronary intervention (PCI) in patients with acute STEMI with completely occluded culprit artery after pre-hospital thrombolysis (PT).
Methods: Altogether 1,103 consecutive patients with STEMI admitted to the coronary care unit and submitted to PCI from January 2005 to January 2015 were included in the analysis. The clinical and angiographic characteristics, in-hospital outcomes, as well as predictors of no-reflow phenomenon were analyzed.
Results: Altogether 708 patients (64.2%) with a completely occluded culprit artery (initial TIMI flow ≤ 1) were included in the analysis. Overall, 78(11%) patients who received PCI after PT (PT-group) were compared with 630(89%) patients who received primary PCI (PPCI-group). The rates of no-reflow (14.1% vs 6.8%; P=0.02) and recurrent MI (5.1% vs 1.3%; P=0.03) were significantly higher in the PT-group. The rates of death (5.2% vs 5.1%; P=0.61) and stent thrombosis (3.8% vs 1.3%; P=0.11), as well as MACE (9.0% vs 7.0%; P=0.52), were comparable between the groups. After univariate analysis, several clinical and procedural characteristics were associated with no-reflow, but only PT was associated with recurrent MI (OR=4.20; 95% CI 1.24-14.3; P=0.02). After multivariate analysis, PT remained an independent predictor of no-reflow (OR=2.53; 95% CI 1.17-5.46; P=0.015)
Conclusion: PCI in patients with STEMI and completely occluded culprit artery after PT was associated with higher levels of no-reflow and recurrent MI. Completely occluded culprit artery after PT was an independent predictor of no-reflow during PCI.
- Topol EJ. Acute myocardial infarction: thrombolysis. Heart 2000; 83(3):122–6. PubMed
- Ko DT, Atzema CL, Donovan LR, Graham MM, Huynh T, So DY, et al. Rescue percutaneous coronary interventions for failed fibrinolytic therapy in ST-segment elevation myocardial infarction: a population-based study. Am Heart J. 2011; 161(4):764-770.e1. doi: 10.1016/j.ahj.2010.12.016. PubMed
- Wijeysundera HC, Vijayaraghavan R, Nallamothu BK, Foody JM, Krumholz HM, Phillips CO, et al. Rescue angioplasty or repeat fibrinolysis after failed fibrinolytic therapy for ST-segment myocardial infarction: a meta-analysis of randomized trials. J Am Coll Cardiol. 2007; 49(4):422-30. PubMed
- Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y, et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013;368(15):1379-87. doi: 10.1056/NEJMoa1301092. PubMed
- Bessonov IS, Kuznetsov VA, Zyryanov IP, Musikhina NA, Sapozhnikov SS, Takkand AG, Zateyshchikov DA. [Percutaneous Coronary Intervention in Patients With Acute Myocardial Infarction With ST-Segment Elevation After Prehospital Thrombolysis]. Kardiologiia. 2016;56(2):5-10. [Article in Russian]. PubMed
- Bonnefoy E, Steg PG, Boutitie F, Dubien PY, Lapostolle F, Roncalli J, et al. Comparison of primary angioplasty and prehospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J. 2009;30(13):1598-606. doi: 10.1093/eurheartj/ehp156. PubMed
- Danchin N, Puymirat E, Steg PG, Goldstein P, Schiele F, Belle L, et al. Five-year survival in patients with ST-segment-elevation myocardial infarction according to modalities of reperfusion therapy: the French Registry on Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) 2005 Cohort. Circulation. 2014;129(16):1629-36. doi: 10.1161/CIRCULATIONAHA.113.005874. PubMed
- Claeys MJ, de Meester A, Convens C, Dubois P, Boland J, De Raedt H, et al. Contemporary mortality differences between primary percutaneous coronary intervention and thrombolysis in ST-segment elevation myocardial infarction. Arch Intern Med. 2011;171(6):544-9. doi: 10.1001/archinternmed.2011.57. PubMed
- Westerhout CM, Bonnefoy E, Welsh RC, Steg PG, Boutitie F, Armstrong PW. The influence of time from symptom onset and reperfusion strategy on 1-year survival in ST-elevation myocardial infarction: a pooled analysis of an early fibrinolytic strategy versus primary percutaneous coronary intervention from CAPTIM and WEST. Am Heart J. 2011;161(2):283-90. doi: 10.1016/j.ahj.2010.10.033. PubMed
- Siontis KC, Barsness GW, Lennon RJ, Holmen JL, Wright RS, Bell MR, Gersh BJ. Pharmacoinvasive and Primary Percutaneous Coronary Intervention Strategies in ST-Elevation Myocardial Infarction (from the Mayo Clinic STEMI Network). Am J Cardiol. 2016 Jun 15;117(12):1904-10. doi: 10.1016/j.amjcard.2016.03.036. PubMed
- Steg PG, Bonnefoy E, Chabaud S, Lapostolle F, Dubien PY, Cristofini P, Leizorovicz A, Touboul P; Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) Investigators. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation 2003;108(23):2851-6. PubMed
- Gershlick AH, Westerhout CM, Armstrong PW, Huber K, Halvorsen S, Steg PG, et al. Impact of a pharmacoinvasive strategy when delays to primary PCI are prolonged. Heart. 2015;101(9):692-8. doi: 10.1136/heartjnl-2014-306686. PubMed
- Galasso G, Schiekofer S, D'Anna C, Gioia GD, Piccolo R, Niglio T, Rosa RD, et al. No-reflow phenomenon: pathophysiology, diagnosis, prevention, and treatment. A review of the current literature and future perspectives. Angiology. 2014 Mar;65(3):180-9. doi: 10.1177/0003319712474336. PubMed
- Bouleti C, Mewton N, Germain S. The no-reflow phenomenon: State of the art. Arch Cardiovasc Dis. 2015;108(12):661-74. doi: 10.1016/j.acvd.2015.09.006. PubMed
- Bohmer E, Hoffmann P, Abdelnoor M, Arnesen H, Halvorsen S. Efficacy and safety of immediate angioplasty vs. ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction). J Am Coll Cardiol. 2010;55(2):102-10. doi: 10.1016/j.jacc.2009.08.007. PubMed
- Borgia F, Goodman SG, Halvorsen S, Cantor WJ, Piscione F, Le May MR, et al. Early routine percutaneous coronary intervention after fibrinolysis vs. standard therapy in ST-segment elevation myocardial infarction: a meta-analysis. Eur Heart J. 2010 Sep;31(17):2156-69. doi: 10.1093/eurheartj/ehq204. PubMed
- D’Souza SP, Mamas MA, Fraser DG, Fath-Ordoubadi F. Routine early coronary angioplasty vs. ischaemia-guided angioplasty after thrombolysis in acute ST-elevation myocardial infarction: a meta-analysis. Eur Heart J. 2011;32(8):972-82. doi: 10.1093/eurheartj/ehq398. PubMed
Received January 11, 2018.
Accepted February 5, 2018.
©2018 International Medical Research and Development Corporation.