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Fibrinolytic agent plus urgent PCI reduced mortality in older STEMI patients
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A strategy involving a reduced dose of fibrinolytic agents plus urgent PCI was associated with improved survival at 30 days compared with primary PCI in a cohort of older patients with STEMI.
The researchers wrote that current evidence suggests that pre-hospital administration of reduced-dose fibrinolytic agents with urgent PCI may be as effective as primary PCI in STEMI. However, a bleeding risk, particularly among older patients, has been observed with the fibrinolytic agent strategy.
In the current analysis, 30-day outcomes for both approaches in patients aged at least 75 years were reported. There were 120 patients in the fibrinolytic agent plus urgent PCI cohort and 94 patients in the primary PCI cohort.
Thirty-day mortality served as the primary comparator. Other endpoints included stroke, reinfarction and major bleeding.
Age, cardiac risk factors and ischemic times were similar between the two groups.
The fibrinolytic agent strategy yielded a 30-day mortality rate of 4.2% compared with 18.1% for primary PCI (P<.01).
The investigators reported no significant differences between the two groups regarding the individual secondary outcome measures. However, the fibrinolytic agent strategy was associated with an 11.7% rate of the composite of the three secondary endpoints compared with 22.3% for primary PCI (P=.04). Five bleeding events occurred in the combination group and two occurred among patients undergoing primary PCI.
Cardiogenic shock on hospital arrival occurred in 15% of the investigational strategy patients and 26% of the primary PCI patients (P=.05). The fibrinolytic strategy also yielded lower rates of TIMI grade 0 flow (35% vs. 61%; P<.01).
The investigators concluded that the fibrinolytic agent plus urgent PCI strategy “in a coordinated system of care was associated with reduced 30-day mortality, earlier infarct artery patency, and lower incidence of cardiogenic shock at arrival compared with [primary] PCI, without apparent bleeding, stroke or reinfarction penalties.”
Disclosure: The researchers report no relevant financial disclosures.
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