Percutaneous Coronary Intervention After Prehospital Thrombolysis in Patients With Acute ST-Elevation Myocardial Infarction

Purpose: to analyze results of percutaneous coronary intervention (PCI) in patients with acute ST-elevation myocardial infarction performed after prehospital thrombolysis in real clinical practice. Material. In the period from 2008 to 2013 144 and 577 patients were subjected to PCI after prehospital thrombolysis with tenecteplase (pharmacoinvasive group - PhG) and primary PCI (PPCIG), respectively. Results. PhG compared with PPCIG contained younger patients (mean age 56.9 +/- 0.2 and 59.6 +/- 1.2 years, respectively; p=0.01), and higher portion of men (84.7 and 72.6%, respectively; p=0.003). Frequency of complete occlusion of infarct-related artery in PhG was lower (41.7 and 71.4%, respectively; p<0.001). Time from onset of pain to administration of a thrombolytic drug was 80 (55; 172) min, PCI was performed in 270 (120; 540) min after thrombolysis. In PPCIG time from onset of symptoms to hospital admission was 120 (60; 230) min, "door-to-balloon" time 86 (67; 115) min. There was no difference between groups in the composite outcome comprising death, recurrent infarction and stent thrombosis, as well as in frequency of bleeding complications at the puncture site. Rate of major cardiac complications during hospital stay was independently associated with elderly age (odds ratio [OR 1.05; 95% confidence interval [CI] 1.02 to 1.08), previous myocardial infarction (OR 2.21, 95% CI 1.18 to 4.18), and total occlusion of infarct-related artery (OR 4.08, 95%CI 1.86 to 8.94). Pharmacoinvasive strategy was not associated with reduction of the incidence of major cardiac events (OR 1.25, 95%CI 0.60 to 2.60). Conclusion. In settlements with PCI capable hospital primary PCI is clinically and economically justified.