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Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction

BACKGROUND: ST-elevation myocardial infarction (STEMI) refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers. Rapid restoration of brisk flow in the coronary vasculature is critical...

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Autores principales: Sethi, Rishi, Mohan, Lalit, Vishwakarma, Pravesh, Singh, Abhishek, Sharma, Swati, Bhandari, Monika, Shukla, Ayush, Sharma, Akhil, Chaudhary, Gaurav, Pradhan, Akshyaya, Chandra, Sharad, Narain, Varun Shankar, Dwivedi, Sudhanshu Kumar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Baishideng Publishing Group Inc 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850672/
https://www.ncbi.nlm.nih.gov/pubmed/36714366
http://dx.doi.org/10.4330/wjc.v15.i1.23
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author Sethi, Rishi
Mohan, Lalit
Vishwakarma, Pravesh
Singh, Abhishek
Sharma, Swati
Bhandari, Monika
Shukla, Ayush
Sharma, Akhil
Chaudhary, Gaurav
Pradhan, Akshyaya
Chandra, Sharad
Narain, Varun Shankar
Dwivedi, Sudhanshu Kumar
author_facet Sethi, Rishi
Mohan, Lalit
Vishwakarma, Pravesh
Singh, Abhishek
Sharma, Swati
Bhandari, Monika
Shukla, Ayush
Sharma, Akhil
Chaudhary, Gaurav
Pradhan, Akshyaya
Chandra, Sharad
Narain, Varun Shankar
Dwivedi, Sudhanshu Kumar
author_sort Sethi, Rishi
collection PubMed
description BACKGROUND: ST-elevation myocardial infarction (STEMI) refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers. Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity. In patients with STEMI who could not receive primary percutaneous coronary intervention (PCI) on time, pharmacoinvasive strategy (thrombolysis followed by timely PCI within 3-24 h of its initiation) is an effective option. AIM: To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis. METHODS: This was a physician-initiated, single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries. Patients received routine pharmacoinvasive therapy (PCI within 3-24 h of thrombolysis) in one group and delayed pharmacoinvasive therapy (PCI within 24-72 h of thrombolysis) in another group. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within 30 d of the procedure. The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification, angina, and dyspnea within 30 d. RESULTS: The mean age in the two groups was comparable (55.1 ± 10.1 years vs 54.2 ± 10.5 years, P = 0.426). Diabetes was present among 20.2% and 22.1% of patients in the routine and delayed groups, respectively. Smoking rate was 54.6% and 55.8% in the routine and delayed groups, respectively. Thrombolysis was initiated within 6 h of onset of symptoms in both groups (P = 0.125). The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9 ± 5.3 h and 44.1 ± 14.7 h, respectively. No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d (8.7% vs 12.9%, P = 0.152). Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation. Secondary endpoints such as angina, dyspnea, and major bleeding were non-significantly different between the two groups. CONCLUSION: Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy.
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spelling pubmed-98506722023-01-26 Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction Sethi, Rishi Mohan, Lalit Vishwakarma, Pravesh Singh, Abhishek Sharma, Swati Bhandari, Monika Shukla, Ayush Sharma, Akhil Chaudhary, Gaurav Pradhan, Akshyaya Chandra, Sharad Narain, Varun Shankar Dwivedi, Sudhanshu Kumar World J Cardiol Prospective Study BACKGROUND: ST-elevation myocardial infarction (STEMI) refers to a clinical syndrome that features symptoms of myocardial ischemia with consequent ST-elevation on electrocardiography and an associated rise in cardiac biomarkers. Rapid restoration of brisk flow in the coronary vasculature is critical in reducing mortality and morbidity. In patients with STEMI who could not receive primary percutaneous coronary intervention (PCI) on time, pharmacoinvasive strategy (thrombolysis followed by timely PCI within 3-24 h of its initiation) is an effective option. AIM: To analyze the role of delayed pharmacoinvasive strategy in the window period of 24-72 h after thrombolysis. METHODS: This was a physician-initiated, single-center prospective registry between January 2017 and July 2017 which enrolled 337 acute STEMI patients with partially occluded coronary arteries. Patients received routine pharmacoinvasive therapy (PCI within 3-24 h of thrombolysis) in one group and delayed pharmacoinvasive therapy (PCI within 24-72 h of thrombolysis) in another group. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE) within 30 d of the procedure. The secondary endpoints included major bleeding as defined by Bleeding Academic Research Consortium classification, angina, and dyspnea within 30 d. RESULTS: The mean age in the two groups was comparable (55.1 ± 10.1 years vs 54.2 ± 10.5 years, P = 0.426). Diabetes was present among 20.2% and 22.1% of patients in the routine and delayed groups, respectively. Smoking rate was 54.6% and 55.8% in the routine and delayed groups, respectively. Thrombolysis was initiated within 6 h of onset of symptoms in both groups (P = 0.125). The mean time from thrombolysis to PCI in the routine and delayed groups was 16.9 ± 5.3 h and 44.1 ± 14.7 h, respectively. No significant difference was found for the occurrence of measured clinical outcomes in the two groups within 30 d (8.7% vs 12.9%, P = 0.152). Univariate analysis of demographic characteristics and risk factors for patients who reported MACCE in the two groups did not demonstrate any significant correlation. Secondary endpoints such as angina, dyspnea, and major bleeding were non-significantly different between the two groups. CONCLUSION: Delayed PCI pharmacoinvasive strategy in a critical diseased but not completely occluded artery beyond 24 h in patients who have been timely thrombolyzed seems a reasonable strategy. Baishideng Publishing Group Inc 2023-01-26 2023-01-26 /pmc/articles/PMC9850672/ /pubmed/36714366 http://dx.doi.org/10.4330/wjc.v15.i1.23 Text en ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved. https://creativecommons.org/licenses/by-nc/4.0/This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
spellingShingle Prospective Study
Sethi, Rishi
Mohan, Lalit
Vishwakarma, Pravesh
Singh, Abhishek
Sharma, Swati
Bhandari, Monika
Shukla, Ayush
Sharma, Akhil
Chaudhary, Gaurav
Pradhan, Akshyaya
Chandra, Sharad
Narain, Varun Shankar
Dwivedi, Sudhanshu Kumar
Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction
title Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction
title_full Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction
title_fullStr Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction
title_full_unstemmed Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction
title_short Feasibility and efficacy of delayed pharmacoinvasive therapy for ST-elevation myocardial infarction
title_sort feasibility and efficacy of delayed pharmacoinvasive therapy for st-elevation myocardial infarction
topic Prospective Study
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9850672/
https://www.ncbi.nlm.nih.gov/pubmed/36714366
http://dx.doi.org/10.4330/wjc.v15.i1.23
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