Abstract 4325: Long-term Effects of Early versus Late PCI After Thrombolysis in Acute Myocardial Infarction
OBJECTIVES The Southwest German Interventional Study in Acute Myocardial Infarction (SIAM III) investigated the effects of early versus late percutaneous coronary intervention (PCI) after thrombolysis in acute ST-elevation myocardial infarction (STEMI) as opposed to a more conservative treatment regimen. So far, no long-term data (mean follow-up time of 6.9±2.9 years; maximum 9.4 years) on a pharmacoinvasive approach in STEMI have been reported.
BACKGROUND Treatment of STEMI by thrombolysis has limited efficacy and high re-occlusion rates of the infarct-related artery. There are conflicting data on the impact of PCI after thrombolysis compared with thrombolytic therapy alone.
METHODS The SIAM III study was a multicenter, randomized, prospective, controlled trial in patients receiving thrombolysis in AMI (<12 hrs). Patients of group I were transferred within 6 h after thrombolysis for coronary angiography including stenting. Group II received elective coronary angiography two weeks after thrombolysis with stent implantation.
RESULTS In total 197 patients were randomized, 163 patients fulfilled the secondary (angiographic) inclusion criteria (82 in group I, 81 in group II). During a mean follow-up time of 6.9±2.9 years (maximum 9.4 years), transfer for immediate stenting was associated with a significant reduction of the combined end point of ischemic events, death, reinfarction, and target lesion revascularization (42.7% vs. 64.2%; p=0.005). Long-term survival was significantly higher with the early parmacoinvasive approach (mortality 14.6% vs. 27.2%; p=0.037).
CONCLUSIONS Transfer for immediate stenting after thrombolysis leads to a significant improved event-free survival compared to a more conservative approach.