Abstract 1761: Decreased In-Hospital Mortality Of Patients with ST-Segment Elevation Myocardial Infarction Treated with Pharmacoinvasive Therapy: Is Benefit of Facilitated PCI Limited to Prolonged Door-to-Balloon Time?
BACKGROUND: Prolonged door-to-balloon (DTB) time is associated with worse outcomes in patients with ST-segment elevation myocardial infarction (STEMI) transferred for percutaneous coronary intervention (PCI). The use of facilitated PCI with antecedent pharmacotherapy remains controversial, potentially due to benefit limited to patients with longer door-to-balloon time.
METHODS: We assessed clinical, angiographic characteristics and in-hospital outcomes in 1123 consecutive STEMI patients without cardiogenic shock who presented within 12 hours of symptom onset. 617 patients presented at community hospitals and were transferred for PCI with (493 patients, facilitated PCI group) or without (124 patients, primary PCI group) antecedent treatment with bolus fibrinolytics and/or glycoprotein (GP) IIb/IIIa. Clinical outcomes were further compared to 506 STEMI patients treated at the same center with primary PCI (On-Site PCI) without facilitation. The groups were then divided according to DTB times of > or < 120 min. Major adverse cardiac events (MACE), including in-hospital mortality, re-infarction, stroke and emergency revascularization were compared.
RESULTS: Facilitated PCI patients were younger, with less 3-vessel disease. Other clinical/angiographic characteristics were similar. Compared with primary PCI, facilitated PCI was associated with higher pre-TIMI 3 flow (53% vs. 29.8%, p < 0.001) and a significantly lower in-hospital mortality (4.8% vs. 1.2%, p = 0.02), with similar bleeding. Mortality was similar to On-Site PCI (1.4 %, p = NS) irrespective of gender. In-hospital MACE was significantly lower after facilitated PCI in patients with a DTB > 120 min.
CONCLUSION: The use of pharmacoinvasive therapy obviates prolonged door-to-balloon times in community hospital STEMI patients requiring inter-hospital transfer, resulting in similar in-hospital outcomes compared to patients presenting directly to a tertiary center.