Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry

被引：10

作者：

Zubaid, Mohammad ^{[1
]}

Khraishah, Haitham ^{[2
]}

Alahmad, Barrak ^{[3
]}

Rashed, Wafa ^{[4
]}

Ridha, Mustafa ^{[5
]}

Alenezi, Fahad ^{[6
]}

Aljarralah, Mohamad ^{[7
]}

Al-Marri, Khalid ^{[8
]}

Almutairi, Mohammad ^{[9
]}

Althalji, Khalid ^{[6
]}

Alfaddagh, Abdulhamied ^{[10
]}

机构：

[1] Kuwait Univ, Fac Med, Dept Med, Kuwait, Kuwait

[2] Harvard Med Sch, Beth Israel Deaconess Med Ctr, Dept Med, Boston, MA 02115 USA

[3] Harvard Univ, TH Chan Sch Publ Hlth, Environm Hlth Dept, Boston, MA 02115 USA

[4] Minist Hlth, Dept Med, Div Cardiol, Mubarak Alkabeer Hosp, Kuwait, Kuwait

[5] Minist Hlth, Dept Cardiol, Salman Aldabous Cardiac Ctr, Kuwait, Kuwait

[6] Minist Hlth, Dept Med, Div Cardiol, Alfarwaniya Hosp, Kuwait, Kuwait

[7] Minist Hlth, Dept Cardiol, Sabah Alahmad Cardiac Ctr, Kuwait, Kuwait

[8] Minist Hlth, Dept Cardiol, Chest Dis Hosp, Kuwait, Kuwait

[9] Aljahra Hosp, Dept Med, Div Cardiol, Kuwait, Kuwait

[10] Johns Hopkins Univ, Ciccarone Ctr Prevent Cardiovasc Dis, Baltimore, MD USA

来源：

ANNALS OF GLOBAL HEALTH | 2020年 / 86卷 / 01期

关键词：

GULF REGISTRY; TASK-FORCE; REPERFUSION; OUTCOMES; DELAYS; FIBRINOLYSIS; GUIDELINES; EXPERIENCE; TRENDS; PCI;

D O I：

10.5334/aogh.2632

中图分类号：

R1 [预防医学、卫生学];

学科分类号：

1004 ; 120402 ;

摘要：

Background: A pharmacoinvasive reperfusion strategy is recommended for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (PCI) cannot be achieved in a timely fashion. This is based on a limited number of trials. The effectiveness of this strategy in the real-world is unclear. Objectives: To compare the effectiveness of pharmacoinvasive strategy versus primary PCI using a nationwide prospective registry of STEMI patients. Methods: We examined 936 STEMI patients from the reperfusion in ST-elevation myocardial infarction in Kuwait (REPERFUSE Kuwait) registry who underwent either primary PCI or pharmacoinvasive reperfusion. A composite outcome was measured based on death, congestive heart failure, reinfarction or stroke prospectively ascertained during hospital stay and up to one-year follow-up. The association between reperfusion strategy and the composite outcome was assessed using multivariate regression and Poisson proportional hazard model. Results: Compared to the pharmacoinvasive group, those undergoing primary PCI had higher Killip class on presentation and required more blood transfusions during hospitalization. There was no significant difference between primary PCI and pharmacoinvasive strategy with regards to the incidence of the composite outcome during the in-hospital period (RR = 1.0; 95% CI 0.98-1.02; p = 0.96) after adjustment for possible confounders. Over one-year follow-up, the survival of the two groups was not different (p = 0.66). The incidence of major bleeding was similar in both groups. Conclusion: STEMI patients treated with a pharmacoinvasive strategy have comparable outcomes to those treated with primary PCI with no increased risk of major bleeding. These real-world data support the use of a pharmacoinvasive strategy when primary PCI cannot be achieved in a timely fashion.

引用

页数：10