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STEMI survival at 5 years similar after primary PCI, fibrinolysis
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Five-year results from the FAST-MI registry suggest that a pharmaco-invasive strategy may be an acceptable alternative for some patients with STEMI in whom immediate primary PCI is not an option.
Researchers evaluated mortality at 5 years among 1,492 adults with STEMI enrolled in the FAST-MI 2005 registry according to reperfusion therapy use and type.
Overall, of the 1,492 patients with a time to first call of 12 hours or less, 39% had primary PCI, 30% received fibrinolysis and 31% received no reperfusion.
The researchers calculated a crude 5-year survival rate of 88% for patients who received fibrinolysis, 83% for primary PCI and 59% for no reperfusion. In the fibrinolysis group, patients with prehospital treatment had a survival rate of 90%, whereas those treated in the hospital had an 85% survival rate.
Compared with no reperfusion, both primary PCI patients (adjusted HR=0.57; 95% CI, 0.43-0.74) and those treated with a pharmaco-invasive strategy (adjusted HR=0.48; 95% CI, 0.35-0.68) had a reduced risk for mortality at 5 years. Researchers also calculated an adjusted HR of 0.73 (95% CI, 0.5-1.06) for 5-year mortality for fibrinolysis vs. primary PCI, but this difference was not significant.
Within the fibrinolysis group, the mortality risk was further reduced among patients who received treatment before hospitalization (adjusted HR=0.57 vs. primary PCI; 95% CI, 0.36-0.88) or within 90 minutes of a call made within 180 minutes of symptom onset (adjusted HR=0.63; 95% CI, 0.34-0.91). Patients treated with fibrinolysis in the hospital were at increased risk for 5-year mortality compared with those who had primary PCI (HR=1.19; 95% CI, 0.72-1.96).
A secondary analysis of 348 pairs of propensity score-matched patients indicated no significant difference in survival between patients who received fibrinolysis or primary PCI (87.9% for fibrinolysis vs. 85.3% for primary PCI; P=.3). Similar results were observed among 257 matched pairs of patients who received treatment shortly after making the initial call (87% for fibrinolysis vs. 85% for primary PCI).
“To the best of our knowledge, this is the first real-world study comparing 5-year outcomes in STEMI patients with regard to reperfusion therapy with either primary PCI or fibrinolytic treatment as part of a pharmaco-invasive approach,” the researchers wrote. “… Overall, in the absence of contraindication and considering the potential difficulty of implementing an emergency PCI service available 24 hours a day and 7 days a week in some settings, a pharmaco-invasive strategy seems to represent a safe alternative to primary PCI.”
Disclosure: See the full study for a list of the researchers’ relevant financial disclosures.
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