Abstract 15493: Comparison of Myocardial Scar Indices for Patients Treated With Pre-Hospital Reduced Dose Fibrinolytic Followed by Percutaneous Coronary Intervention versus Percutaneous Coronary Intervention Alone for Treatment of ST-Elevation Myocardial Infarction
Introduction: Current standard treatment for ST-elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PPCI). Early reperfusion results in shorter ischemic time (IT), smaller infarct size and lower mortality. Since fibrinolysis can be initiated earlier than PPCI; for over 7 years, we have used a strategy of field evaluation for STEMI using 12 lead ECGs transmitted by emergency services personnel with over-read by emergency center physicians. Appropriate patients receive pre-hospital reduced dose fibrinolytic (10 units reteplase) along with aspirin, clopidogrel, and heparin, and are transported for urgent PCI (FAST-PCI strategy).
Hypothesis: Patient with STEMI in FAST-PCI group have reduced myocardial scar and microvascular obstruction (MVO) indices measured by cardiac magnetic resonance (CMR) compared with those in PPCI.
Methods: Patients with CMR performed 3 to 5 days after STEMI at our tertiary center were prospectively included for retrospective analysis. Demographic, clinical, angiographic data and outcomes were compared. We defined IT as time from onset of pain to device activation. Patients were divided into groups based on IT (<120, 120-179, ≥ 180 minutes). Within each group, patients were compared by PPCI and FAST-PCI groups. The primary endpoints were myocardial scar and MVO indices as defined in the table.
Results: Between 1/2007 and 2/2014, we treated 1323 STEMI patients of which 357 (26.9%) had CMR after STEMI. FAST-PCI was employed in 216 (60.5%) and PPCI in 141 (39.5%) patients. The two treatment groups in each IT interval were well matched for age, cardiac risk factors, left main and left anterior descending artery infarct. Data are shown in the table.
Conclusions: For STEMI patients with IT < 3 hours, FAST-PCI had reduced myocardial scar and MVO indices compared to PPCI. However, for patients with IT ≤ 3 hours, there was no significant difference in those indices between the two treatment groups
Author Disclosures: A. Solhpour: None. K. Chang: None. P. Balan: None. C. Loghin: None. S.M. Sdringola: None. A.E. Denktas: None. A.L. Gunter: None. D.W. Maland: None. E. Stautberg: None. H. Anderson: None. R.W. Smalling: None.
- © 2014 by American Heart Association, Inc.