Abstract 13049: Clinical Outcomes in ST-Elevation and Myocardial Infarction Patients Treated with the Pharmacoinvasive strategy in the Ottawa STEMI Program

Abstract

Background The pharmacoinvasive strategy has proven to be superior to fibrinolysis alone in reducing ischemic events in pts with ST-Elevation myocardial infarction (STEMI). It has been recommended that STEMI programs adopt such a strategy when primary percutaneous coronary intervention (PCI) is not an option. There is currently limited real-world data on this approach. We sought to determine the outcomes of pts treated with a pharmacoinvasive (PI) approach applied in the Ottawa Regional STEMI system. Methods The University of Ottawa Heart Institute’s (UOHI) Regional STEMI Program has evolved to use primary PCI for 9 hospitals located within 60 km of the PCI centre, and a PI strategy for 7 community hospitals beyond this limit. We studied pts referred to the UOHI during April 2009 -May 2010 who were treated with the PI strategy. The primary endpoint was of a composite of death, re-infarction, or stroke during the index hospitalization. Secondary endpoints included TIMI bleeding during hospitalization and death at 180 days. Results We identified 79 STEMI pts transferred to the UOHI after receiving PI therapy (94% tenecteplase, 6% reteplase) and had a coronary angiogram performed within 24 hrs. Rescue PCI was needed in 42%. Amongst the 79 pts, 75% were male, 20% were diabetic, 48% had hypertension, and 53% were current smokers. Median age was 61 ± 11yrs. Location of the infarct was anterior in 50% of pts and 89% of pts presented as Killip class I. PCI performed in 89% of pts, coronary artery bypass surgery (CABG) in 8.6% of pts, and 3.4% treated with medical therapy. Initial angiography revealed baseline TIMI grade 3 flow in 51% of pts and post-intervention TIMI 3 flow in 97%. During index hospitalization, primary outcome occurred in 2 (2.6%) pts during hospitalization; death occurred in 1 pt (1.3%), and stroke in 1 pt (1.3%). No pts had re-infarction. TIMI non-CABG major bleeding occurred in 2 pts (2.5%) and TIMI non-CABG minor bleeding in 5 pts (6.3%). Of the 6 pts who had CABG, a TIMI major bleed occurred in 1 /79 (1.3%) during hospitalization. At the 180-day follow-up, death had occurred in 2 (2.5%) pts and re-infarction in 3 (3.8%) pts. Conclusion Our results indicate that a PI strategy is feasible in a real-world setting and can be associated with favorable clinical outcomes.