Iranian Heart Journal

Iranian Heart Journal

Comparison of the 3-Month Outcome Between Primary PCI and Thrombolytic Therapy Concerning the Left Ventricular Ejection Fraction of STEMI Patients at 90-Minute Intervals

Document Type : Original Article

Authors
Mohammad Asadpour Piranfar 1
Mehrdad Jafari Fesharaki 2
Reyhaneh Taati 1
1 Department of Cardiology, Taleghani Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
2 Department of Cardiology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
Abstract
Background: Standard treatment in patients with ST‐elevation myocardial infarction (STEMI) is the reperfusion therapy of coronary arteries with the most appropriate therapeutic method. The purpose of the present study was to compare the 3-month outcome between primary percutaneous coronary intervention (P-PCI) and thrombolytic therapy regarding the ejection fraction (EF) of patients with STEMI who were referred to 2 hospitals in Tehran with the same door-to-balloon and door-to-needle times (≈90 min).
 
Methods: This cohort study enrolled 43 patients referred to Taleghani Hospital and Labbafinejad Hospital, affiliated with Shahid Beheshti University of Medical Sciences, in Tehran, Iran. Based on a researcher-made questionnaire, the initial and the 3-month EFs in the P-PCI group (n=19) and the thrombolytic therapy group (n=24) were determined and compared.
 
Results: No significant differences were found in demographic variables between the 2 therapeutic methods. Most participants were aged 60 years or older and male. The outcome of P-PCI and thrombolytic therapy in terms of the EF showed no significant differences at baseline (41% vs 42.6%) and 3 months’ follow-up (50.2% vs 50.3%) (P>0.05). Additionally, the mortality and rehospitalization rates were the same in both groups (P>0.05).
 
Conclusions: No significant differences were observed in the 3-month outcome between P-PCI and thrombolytic therapy at 90-minute treatment intervals concerning the EF of patients with STEMI. Thus, either one may be used based on access to the Cath Lab and the patient’s situation. (Iranian Heart Journal 2021; 22(4): 45-53)
Keywords
Primary PCI
Thrombolytic therapy
STEMI
  1. Tamis‐Holland JE, O'Gara P. Highlights From the 2013 ACCF/AHA guidelines for the management of ST‐Elevation Myocardial Infarction and Beyond. Clinical Cardiology. 2014; 37(4):252-9. DOI:10.1002/clc.22258.
  2. Fuster V, Walsh RA, Harrington RG. Chapter 40: ST-Segment Elevation Myocardial Infarction. Hurst's the heart. Volumes: two. 13th ed. New York, United States: McGraw-Hill Education - Europe; 2011. p. 2500. ISBN: 0071636463.
  3. Mann DL, Zipes DP, Libby P, Bonow RO. Braunwald's heart disease: A textbook of cardiovascular medicine. Volumes: Two. 10 ed: Saunders; 2014. p. 2128 ISBN: 1455751332.
  4. Rahnama Z, Taghadosi M, Mazochi M. Comparison of quality of life before and after the therapeutic interventions in patients with acute coronary syndrome. Feyz. 2014;18(5):440-7. DOI.Persian.
  5. Lincoff AM. Managing acute coronary syndromes: decades of progress. Cleveland Clinic Journal oF Medicine. 2014;81(4):233-42. DOI: 10.3949/ccjm.81gr.13002
  6. Rajabi-Moghadam H, Raygan F, Nourddini M, Mousavi SGA, Taghadosi M, Zahedi M. Evaluating in-hospital delay for fibrinolytic therapy of myocardial infarction patients with acute ST-elevation in Kashan Shahid-Beheshti hospital during 2007-2010. KAUMS Journal (FEYZ). 2012; 16(5):468-75. DOI.http://feyz.kaums.ac.ir/article-1-1636-en.html.Persian.
  7. Widimsky P, Wijns W, Fajadet J, De Belder M, Knot J, Aaberge L, et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: Description of the current situation in 30 countries. European Heart Journal. 2010;31(8):943-57. DOI: 10.1093/eurheartj/ehp492.
  8. Saeedian M, Sepehri M, Aghajani H, Khatibi T. Designing a cost based systematic framework for heart stemi patients by PPCI and thrombolytic treatments. Hospital. 2015; 14(3):9-21. DOI.Persian.
  9. Kassaei S, Hassanzadeh Makoei R, Baghaeinia R. First case of STEMI (ST Elevation Myocardial Infarction) treated by manual thrombus suction in Zanjan Province. Journal of Advances in Medical and Biomedical Research. 2010;18(71):90-7. DOI.Persian.
  10. Bates ER. Timeliness of treatment is more important than choice of reperfusion therapy. Cleveland Clinic Journal oF Medicine. 2010; 77(9):567. DOI.
  11. Knot J, Widimsky P, Wijns W, Stenestrand U, Kristensen SD, Van AH, et al. How to set up an effective national primary angioplasty network: lessons learned from five European countries. EuroIntervention: Journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology. 2009; 5(3):299, 301-9. DOI.https://europepmc.org/article/med/19736153.
  12. Safi M, Mohammadpour M, Mojtahedzadeh M, Otoukesh S, Vakili H. Comparison between Primary PCI and thrombolytic therapy results in patients with acute ST-elevation MI. RESEARCHER BULLETIN OF MEDICAL SCIENCES (PEJOUHANDEH) 2010; 14(6(72)):332-6. DOI.Persian.
  13. Dryja T, Kornacewicz-Jach Z, Goracy J, Przybycien K, Jodko L, Skowronek A, et al. Treatment of acute ST-segment elevation myocardial infarction in West Pomerania province of Poland. Comparison between primary coronary intervention and thrombolytic therapy. Kardiologia Polska. 2006; 64(6):591-9. DOI.
  14. Mingo S, Goicolea J, Nombela L, Sufrate E, Blasco A, Millán I, et al. Primary percutaneous angioplasty. An analysis of reperfusion delays, their determining factors, and their prognostic implications. Revista Española de Cardiología (English Edition). 2009; 62(1):15-22. DOI: 10.1016/S1885-5857(09)71509-9.
  15. Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, et al. Heart disease and stroke statistics—2011 update: A report from the American Heart Association. Circulation. 2011; 123(4):e18-e209. DOI:10.1161/CIR.0b013e3182009701
  16. Salem M, Mahrous M, Ramzy A. Six months outcome of rescue percutaneous coronary intervention compared to conservative treatment in patients with ST-segment elevation myocardial infarction with failed fibrinolytic therapy. Cardiovascular System 2015; 3(4):1-5. DOI: 10.7243/2052-4358-3-4.
  17. Wallace EL, Kotter JR, Charnigo R, Kuvlieva LB, Smyth SS, Ziada KM, et al. Fibrinolytic therapy versus primary percutaneous coronary interventions for ST-segment elevation myocardial infarction in Kentucky: Time to establish systems of care? Southern Medical Journal. 2013; 106(7):391. DOI:10.1097/SMJ.0b013e31829ba880.
  18. Itoh T, Fukami Ki, Suzuki T, Kimura T, Kanaya Y, Orii M, et al. Comparison of long-term prognostic evaluation between pre-intervention thrombolysis and primary coronary intervention: A prospective randomized trial. Circulation Journal. 2010; 74(8):1625-34. DOI:10.1253/circj.CJ-09-0873.
  19. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: Executive summary: A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology. 2013; 61(4):485-510. DOI:10.1016/j.jacc.2012.11.018
Iranian Heart Journal
Volume 22, Issue 4
Autumn 2021
Pages 45-53