Abstract 3496: ST-Segment Recovery and Prognosis in Patients with ST-Elevation Myocardial Infarction Reperfused by Prehospital Combination-Fibrinolysis, Prehospital Initiated Facilitated PCI or Primary PCI
Background: Complete ST-segment recovery (STR) is associated with favourable prognosis in ST-elevation myocardial infarction (STEMI). The optimal reperfusion strategy in patients presenting early after symptom onset is still matter of debate. STR for patients treated by either prehospital combination-fibrinolysis or prehospital initiated facilitated percutaneous coronary intervention (PCI) in comparison to primary PCI has not been assessed.
Methods and results: In the Leipzig prehospital fibrinolysis study patients with STEMI (symptoms <6 h) were randomized to either prehospital combination-fibrinolysis (half-dose Reteplase + Abciximab) (n=82; group A) or prehospital initiated facilitated PCI (n=82, group B). Furthermore, a control group of patients with primary PCI (n=136, group C) was prospectively assessed. STR at 90 min was analyzed by blinded observers as percentage resolution. Categorization was performed as complete (>70%), intermediate (70–30%), or no resolution (<30%). The percentage of patients with complete STR was highest in B with 80% vs. 52% A and 52% C (p<0.001 B versus A and C; p=n.s. A versus C). Complete STR resulted in lower event rates for the combined clinical endpoint of death, re-MI and stroke in comparison to intermediate and no STR in group A (complete 9.8%, intermediate 23.8%, no STR 36.8%; p=0.04), B (7.7%, 18.2%, 50.0%; p=0.01), and C (8.6%, 18.4%, 42.9%; p<0.001).
Conclusions: Prehospital initiated facilitated PCI results in a higher percentage of complete STR in comparison to prehospital combination-fibrinolysis or primary PCI. In addition, STR has been confirmed to predict prognosis in timely optimized reperfusion strategies.