Abstract 18599: Comparison of Outcomes for Eldelry Patients 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: The ultimate treatment goal in ST-elevation myocardial infarction (STEMI) is rapid restoration of coronary blood flow. In general, fibrinolysis can be initiated earlier than primary percutaneous coronary intervention (PPCI) but it could be associated with bleeding risk, especially in elderly patients. 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 (termed FAST-PCI strategy).
Methods: We examined the data for elderly patients (≥ 75 years) treated by either a FAST-PCI strategy or conventional 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 February 2006 and April 2013, we treated 1323 STEMI patients of which 214 (16.2%) were ≥75 years. FAST-PCI was employed in 120 (56%) and PPCI in 94 (44%) patients. The groups were well matched for age, cardiac risk factors and ischemic time. Data are shown in the table.
Conclusions: In the elderly patients, compared with a PPCI strategy, the FAST-PCI strategy was associated with earlier infarct artery patency (Less TIMI 0 flow) and reduced 30 day mortality, as well as with lower incidence of cardiogenic shock at presentation without a bleeding penalty.
- © 2013 by American Heart Association, Inc.