Abstract 12274: A Regional Pharmacoinvasive PCI Strategy Incorporating Bleeding Avoidance Strategies
Background: Pharmacoinvasive Therapy (PIT) is a potential treatment for STEMI patients who are not able to achieve primary PCI within guideline recommended time limits. The risk of bleeding complications with PIT has not been studied in the setting of routine use of bleeding avoidance strategies (BAS).
Methods: We analyzed a contemporary multicenter registry (2009-2013) of consecutive patients undergoing PCI as part of a 10 hospital regional algorithm involving 1 PCI center and 9 transfer centers: PIT for hospitals > 60 minutes (N=140) and Primary PCI if < 60 minutes travel time to PCI center (N=346). We compared the risk of HORIZONS Major Bleeding for patients undergoing PIT vs Primary PCI in the setting of routine use of BAS and determined the independent predictors of major bleeding in the entire cohort.
Results: The PIT patients had a median travel time of 103±49 minutes and were more frequently female, had a higher incidence of renal failure and less cardiogenic shock than the primary PCI group. BAS was routine and similar in both groups (Table). Rates of death, stroke, ischemic and major bleeding outcomes were similar among the two groups, and length of stay was shorter in the PIT group. Multivariate logistic models indicated that two independent predictors of major bleeding were cardiac arrest (OR=3.89, 95% CI: 1.2-12.1, p=0.02) and bailout GPI utilization (OR=3.23, 95% CI 1.2-9.9, p =0.03). The PIT strategy in conjunction with BAS did not predict major bleeding (OR=2.1, 95% CI: 0.85-5.44, p=0.11).
Conclusions: We report the largest study of BAS in conjunction with a regional STEMI strategy of PIT: PIT is associated with low rates of bleeding and thrombotic complications. Bleeding and ischemic rates were similar to the primary PCI strategy. PIT in conjunction with BAS is not an independent predictor of bleeding risk in a regional STEMI population.
Author Disclosures: S. Chava: None. S.R. Raza: None. M. El-Haddad: None. J. Priest: None. T. Ashikaga: None. H.L. Dauerman: Consultant/Advisory Board; Modest; Medicines company, Medtronics.
- © 2014 by American Heart Association, Inc.