Abstract 16097: Comparison of Outcomes for Patients With Chronic Kidney Disease Treated With Pre-Hospital Reduced Dose Fibrinolytic Followed by Urgent Percutaneous Coronary Intervention versus Percutaneous Coronary Intervention Alone for Treatment of ST-Elevation Myocardial Infarction
Background: Pre-hospital administration of reduced-dose fibrinolytic restores coronary patency prior to urgent percutaneous coronary intervention (PCI) but it could be associated with stroke or bleeding risk, especially in patients with chronic kidney disease (CKD) for whom recurrence of stroke and bleeding hazards may be increased. For over 7 years we have used a strategy of field evaluation for STEMI using 12 lead EKGs obtained and transmitted by emergency services (EMS) personnel with over-read by emergency center physicians. Appropriate STEMI patients receive pre-hospital reduced dose fibrinolytic (10 units reteplase) along with aspirin, clopidogrel, and heparin, and are transported to our STEMI center for urgent PCI (FAST-PCI strategy).
Methods: We examined the data for CKD patients (ie, glomerular filtration rate < 60 mL/min per 1.73 m2 for 3 months or more) treated by either a FAST-PCI strategy or primary PCI (PPCI). We compared demographic, clinical, angiographic data and outcomes. Ischemic time was defined as time from onset of pain to device activation. Bleeding was assessed using GUSTO criteria.
Results: Between May 2006 and February 2013, we treated 1258 STEMI patients of which 199 (15.8%) had CKD. FAST-PCI was employed in 84 (42%) and PPCI in 115 (58%) patients. Both groups were comparable in age, cardiac risk factors and ischemic time. Data are shown in the table.
Conclusions: The FAST-PCI strategy reduced 30 day mortality among CKD patients with STEMI, without increasing the risk of stroke or bleeding, compared to PPCI. It was also associated with earlier infarct-related artery patency and decreased the incidence of shock at presentation.
- © 2013 by American Heart Association, Inc.