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Title: Evaluation of infarct size and left ventricle function in patients with ST-segment elevation myocardial infarction undergoing prehospital thormbolysis with PCI or delayed primary PCI
Abstract:
Purpose: Reperfusion strategy using full-dose lytics followed by immediate PCI (facilitated PCI) in STEMI is harmful. However combination of prehospital lysis with delayed PCI (pharmaco-invasive treatment) can be beneficial, especially in patients presenting early with long time delay to intervention. Methods: We randomized 45 pts with STEMI < 3h from pain onset, with anticipated delay to PCI >90 minutes to receive prehospital tenecteplase (TNK group, n=22) or to be scheduled for PPCI (PPCI group, n=23). All patients underwent coronary angio/PCI after cathlab admission. Primary endpoint was the infarct size (%) and end-diastolic volume index (LVEDVI, ml/m2) as a marker of LV remodeling assessed by delayed enhancement cardiac magnetic resonance (CMR) at 6-months. Results: Time from first medical contact to intervention was similar in both groups (TNK vs PPCI: 144±51 vs 129±24 minutes; p=0.21). Angiography revealed more frequent infarct-related artery patency in TNK group (TIMI 2+3: 81% vs 43%; p=0.01). Better ST-segment resolution before PCI was found in TNK group (resolution >70%: 53% vs 6%; p=0.003). After PCI no difference in TIMI 3 flow and ST-segment resolution >70% rate was found. The 6-month CMR infarct size was significantly lower in TNK group (7.4±6 vs 11.1±5.6, p=0.019). The 6-month CMR LVEDVI was also lower in TNK group (69.3±21.5 vs 86.3±23.4, p=0.018). Conclusions: ; In patients with early presentation of STEMI transferred for mechanical reperfusion with time delay from first medical contact to intervention >90 minutes faster reperfusion with prehospital thrombolysis followed by PCI resulted in lower infarct size and LV remodeling at 6-month follow up in comparison to primary PCI. Large scale clinical trials are needed to compare clinical outcomes of those two strategies.
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Last modified:
Mar 15, 2023
In our library since:
Nov 21, 2012
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6
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http://dl.cm-uj.krakow.pl:8080/publication/804
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| Edition name | Date |
|---|---|
| ZB-113472 | Mar 15, 2023 |
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