DOI QR코드

DOI QR Code

Long-term clinical outcome of acute myocardial infarction according to the early revascularization method: a comparison of primary percutaneous coronary interventions and fibrinolysis followed by routine invasive treatment

  • Min, Hyang Ki (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital) ;
  • Park, Ji Young (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital) ;
  • Choi, Jae Woong (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital) ;
  • Ryu, Sung Kee (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital) ;
  • Kim, Seunghwan (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital) ;
  • Song, Chang Sup (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital) ;
  • Kim, Dong Shin (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital) ;
  • Song, Chi Woo (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital) ;
  • Kim, Se Jong (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital) ;
  • Kim, Young Bin (Division of Cardiology, Department of Internal Medicine, Eulji General Hospital)
  • Received : 2016.08.19
  • Accepted : 2017.08.10
  • Published : 2017.12.31

Abstract

Background: This study was conducted to provide a comparison between the clinical outcomes of primary percutaneous coronary intervention (PCI) and that of fibrinolysis followed by routine invasive treatment in ST elevation myocardial infarction (STEMI). Methods: A total of 184 consecutive STEMI patients who underwent primary PCI or fibrinolysis followed by a routine invasive therapy were enrolled from 2004 to 2011, and their major adverse cardiovascular events (MACEs) were compared. Results: Among the 184 patients, 146 patients received primary PCI and 38 patients received fibrinolysis. The baseline clinical characteristics were similar between both groups, except for triglyceride level ($68.1{\pm}66.62$ vs. $141.6{\pm}154.3mg/dL$, p=0.007) and high density lipoprotein level ($44.6{\pm}10.3$ vs. $39.5{\pm}8.1mg/dL$, p=0.005). The initial creatine kinase-MB level was higher in the primary PCI group ($71.5{\pm}114.2$ vs. $35.9{\pm}59.9ng/mL$, p=0.010). The proportion of pre-thrombolysis in MI 0 to 2 flow lesions (92.9% vs. 73.0%, p<0.001) was higher and glycoprotein IIb/IIIa inhibitors were administered more frequently in the primary PCI group. There was no difference in the 12-month clinical outcomes, including all-cause mortality (9.9% vs. 8.8%, p=0.896), cardiac death (7.8% vs. 5.9%, p=0.845), non-fatal MI (1.4% vs. 2.9%, p=0.539), target lesion revascularization (5.7% vs. 2.9%, p=0.517), and stroke (0% vs. 0%). The MACEs free survival rate was similar for both groups (odds ratio, 0.792; 95% confidence interval, 0.317-1.980; p=0.618). The clinical outcome of thrombolysis was not inferior, even when compared with primary PCI performed within 90 minutes. Conclusion: Early fibrinolysis with optimal antiplatelet and antithrombotic therapy followed by appropriate invasive procedure would be a comparable alternative to treatment of MI, especially in cases of shorter-symptom-to-door time.

Keywords

References

  1. Carville S, Harker M, Henderson R, Gray H; Guideline Development Group. Acute management of myocardial infarction with ST-segment elevation: summary of NICE guidance. BMJ 2013;347:f4006. https://doi.org/10.1136/bmj.f4006
  2. Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC); Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with STsegment elevation. Eur Heart J 2012;33:2569-619. https://doi.org/10.1093/eurheartj/ehs215
  3. Antman EM, Hand M, Armstrong PW, Bates ER, Green LA, Halasyamani LK, et al. 2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the Canadian Cardiovascular Society endorsed by the American Academy of Family Physicians: 2007 writing group to review new evidence and update the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction, writing on behalf of the 2004 Writing Committee. Circulation 2008;117:296-329. https://doi.org/10.1161/CIRCULATIONAHA.107.188209
  4. Capodanno D, Dangas G. Facilitated/pharmaco-invasive approaches in STEMI. Curr Cardiol Rev 2012;8:177-80. https://doi.org/10.2174/157340312803217157
  5. Keeley EC, Boura JA, Grines CL. Comparison of primary and facilitated percutaneous coronary interventions for ST-elevation myocardial infarction: quantitative review of randomised trials. Lancet 2006;367:579-88. https://doi.org/10.1016/S0140-6736(06)68148-8
  6. Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI):randomized trial. Lancet 2006;367:569-78. https://doi.org/10.1016/S0140-6736(06)68147-6
  7. Zalewski J, Bogaerts K, Desmet W, Sinnaeve P, Berger P, Grines C, et al. Intraluminal thrombus in facilitated versus primary percutaneous coronary intervention: an angiographic substudy of the ASSENT-4 PCI (Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention) trial. J Am Coll Cardiol 2011;57:1867-73. https://doi.org/10.1016/j.jacc.2010.10.061
  8. Ellis SG, Tendera M, de Belder MA, van Boven AJ, Widimsky P, Janssens L, et al. Facilitated PCI in patients with ST-elevation myocardial infarction. N Engl J Med 2008;358:2205-17. https://doi.org/10.1056/NEJMoa0706816
  9. Collet JP, Montalescot G, Le May M, Borentain M, Gershlick A. Percutaneous coronary intervention after fibrinolysis: a multiple meta-analyses approach according to the type of strategy. J Am Coll Cardiol 2006;48:1326-35. https://doi.org/10.1016/j.jacc.2006.03.064
  10. Morrison LJ, Verbeek PR, McDonald AC, Sawadsky BV, Cook DJ. Mortality and prehospital thrombolysis for acute myocardial infarction: a meta-analysis. JAMA 2000;283:2686-92. https://doi.org/10.1001/jama.283.20.2686
  11. Gershlick AH, Banning AP, Myat A, Verheugt FW, Gersh BJ. Reperfusion therapy for STEMI: is there still a role for thrombolysis in the era of primary percutaneous coronary intervention? Lancet 2013;382:624-32. https://doi.org/10.1016/S0140-6736(13)61454-3
  12. Melandri G, Vagnarelli F, Calabrese D, Semprini F, Nanni S, Branzi A. Review of tenecteplase (TNKase) in the treatment of acute myocardial infarction. Vasc Health Risk Manag 2009;5:249-56.