Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry

Background: A pharmacoinvasive reperfusion strategy is recommended for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (PCI) cannot be achieved in a timely fashion. This is based on a limited number of trials. The effectiveness of this strategy in...

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Autores principales:	Mohammad Zubaid, Haitham Khraishah, Barrak Alahmad, Wafa Rashed, Mustafa Ridha, Fahad Alenezi, Mohamad Aljarralah, Khalid Al-Marri, Mohammad Almutairi, Khalid Althalji, Abdulhamied Alfaddagh
Formato:	article
Lenguaje:	EN
Publicado:	Ubiquity Press 2020
Materias:	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
Acceso en línea:	https://doaj.org/article/b7303756293643f58a12cc3172822a6c
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spelling	oai:doaj.org-article:b7303756293643f58a12cc3172822a6c2021-12-02T09:34:57ZEfficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry2214-999610.5334/aogh.2632https://doaj.org/article/b7303756293643f58a12cc3172822a6c2020-02-01T00:00:00Zhttps://annalsofglobalhealth.org/articles/2632https://doaj.org/toc/2214-9996Background: A pharmacoinvasive reperfusion strategy is recommended for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (PCI) cannot be achieved in a timely fashion. This is based on a limited number of trials. The effectiveness of this strategy in the real-world is unclear. Objectives: To compare the effectiveness of pharmacoinvasive strategy versus primary PCI using a nationwide prospective registry of STEMI patients. Methods: We examined 936 STEMI patients from the reperfusion in ST-elevation myocardial infarction in Kuwait (REPERFUSE Kuwait) registry who underwent either primary PCI or pharmacoinvasive reperfusion. A composite outcome was measured based on death, congestive heart failure, reinfarction or stroke prospectively ascertained during hospital stay and up to one-year follow-up. The association between reperfusion strategy and the composite outcome was assessed using multivariate regression and Poisson proportional hazard model. Results: Compared to the pharmacoinvasive group, those undergoing primary PCI had higher Killip class on presentation and required more blood transfusions during hospitalization. There was no significant difference between primary PCI and pharmacoinvasive strategy with regards to the incidence of the composite outcome during the in-hospital period (RR = 1.0; 95% CI 0.98–1.02; p = 0.96) after adjustment for possible confounders. Over one-year follow-up, the survival of the two groups was not different (p = 0.66). The incidence of major bleeding was similar in both groups. Conclusion: STEMI patients treated with a pharmacoinvasive strategy have comparable outcomes to those treated with primary PCI with no increased risk of major bleeding. These real-world data support the use of a pharmacoinvasive strategy when primary PCI cannot be achieved in a timely fashion.Mohammad ZubaidHaitham KhraishahBarrak AlahmadWafa RashedMustafa RidhaFahad AleneziMohamad AljarralahKhalid Al-MarriMohammad AlmutairiKhalid AlthaljiAbdulhamied AlfaddaghUbiquity PressarticleInfectious and parasitic diseasesRC109-216Public aspects of medicineRA1-1270ENAnnals of Global Health, Vol 86, Iss 1 (2020)
institution	DOAJ
collection	DOAJ
language	EN
topic	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270
spellingShingle	Infectious and parasitic diseases RC109-216 Public aspects of medicine RA1-1270 Mohammad Zubaid Haitham Khraishah Barrak Alahmad Wafa Rashed Mustafa Ridha Fahad Alenezi Mohamad Aljarralah Khalid Al-Marri Mohammad Almutairi Khalid Althalji Abdulhamied Alfaddagh Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry
description	Background: A pharmacoinvasive reperfusion strategy is recommended for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (PCI) cannot be achieved in a timely fashion. This is based on a limited number of trials. The effectiveness of this strategy in the real-world is unclear. Objectives: To compare the effectiveness of pharmacoinvasive strategy versus primary PCI using a nationwide prospective registry of STEMI patients. Methods: We examined 936 STEMI patients from the reperfusion in ST-elevation myocardial infarction in Kuwait (REPERFUSE Kuwait) registry who underwent either primary PCI or pharmacoinvasive reperfusion. A composite outcome was measured based on death, congestive heart failure, reinfarction or stroke prospectively ascertained during hospital stay and up to one-year follow-up. The association between reperfusion strategy and the composite outcome was assessed using multivariate regression and Poisson proportional hazard model. Results: Compared to the pharmacoinvasive group, those undergoing primary PCI had higher Killip class on presentation and required more blood transfusions during hospitalization. There was no significant difference between primary PCI and pharmacoinvasive strategy with regards to the incidence of the composite outcome during the in-hospital period (RR = 1.0; 95% CI 0.98–1.02; p = 0.96) after adjustment for possible confounders. Over one-year follow-up, the survival of the two groups was not different (p = 0.66). The incidence of major bleeding was similar in both groups. Conclusion: STEMI patients treated with a pharmacoinvasive strategy have comparable outcomes to those treated with primary PCI with no increased risk of major bleeding. These real-world data support the use of a pharmacoinvasive strategy when primary PCI cannot be achieved in a timely fashion.
format	article
author	Mohammad Zubaid Haitham Khraishah Barrak Alahmad Wafa Rashed Mustafa Ridha Fahad Alenezi Mohamad Aljarralah Khalid Al-Marri Mohammad Almutairi Khalid Althalji Abdulhamied Alfaddagh
author_facet	Mohammad Zubaid Haitham Khraishah Barrak Alahmad Wafa Rashed Mustafa Ridha Fahad Alenezi Mohamad Aljarralah Khalid Al-Marri Mohammad Almutairi Khalid Althalji Abdulhamied Alfaddagh
author_sort	Mohammad Zubaid
title	Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry
title_short	Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry
title_full	Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry
title_fullStr	Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry
title_full_unstemmed	Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry
title_sort	efficacy and safety of pharmacoinvasive strategy compared to primary percutaneous coronary intervention in the management of st-segment elevation myocardial infarction: a prospective country-wide registry
publisher	Ubiquity Press
publishDate	2020
url	https://doaj.org/article/b7303756293643f58a12cc3172822a6c
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Efficacy and Safety of Pharmacoinvasive Strategy Compared to Primary Percutaneous Coronary Intervention in the Management of ST-Segment Elevation Myocardial Infarction: A Prospective Country-Wide Registry

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