A Comparative Study between Pharmacoinvasive Strategy and Primary Percutaneous Coronary Angioplasty on Left Ventricle Function in Patients Presenting by Acute ST Segment Elevation Myocardial Infarction

Abstract

Background: Ischemic heart disease is considered the most common cause of death, worldwide. It accounts for 1.8 million deaths annually in Europe alone. According to the center for disease control (CDC) it’s the most common cause of deaths in Egypt accounting for more than one fifth of the total death count per year (21%), followed by stroke, then cancer. Aim: This work aimed to study and assess the efficacy of a pharmacoinvasive strategy compared with a primary PCI strategy on the left ventricle function in treatment of patient with myocardial infarction. Methods: Our study was prospective non randomized which compares between two groups, both of which had first time acute STEMI admitted to our Tanta University Hospital within the accepted time, which are (group 1) patients who had primary PCI for the infract related artery as a reperfusion therapy and (group 2) patients who had thrombolytic followed by coronary angiography with a window to PCI (pharmacoinvasive technique). Coronary angiography was performed either immediately in case of failed thrombolytic therapy or within 3-24 hrs. Following thrombolytic in case of successful thrombolytic. Both groups presented to the hospital within the accepted time window for reperfusion therapy either (thrombolytic or primary PCI), within 12 hrs. Results: The study compared between the two groups in the acute stage during hospitalization of the patients and after discharge according to Clinical outcomes: (mortality, major adverse cardiac events (MACE) as heart failure symptoms, re-infarction and Cardiac death),angiographic findings (base line TIMI flow score and final TIMI score, single or multi-vessel disease), angiographic complications as dissection and no-reflow, occurrence of contrast induced nephropathy and cerebrovascular events and LV systolic function assessment by echocardiography. Conclusion: In this study, we highlighted the importance of total ischemic time and importance of patient and system related delays in influencing outcomes of STEMI.