Thrombolysis followed by coronary angiography versus primary percutaneous coronary intervention in non-anterior ST-elevation myocardial infarction.

BACKGROUND

Previous studies demonstrated the superiority of primary percutaneous coronary intervention (PCI) over thrombolysis for treatment of ST-elevation myocardial infarction (STEMI); however, this advantage is less evident in low-risk populations. The aim of this study was to assess whether a strategy of thrombolysis followed by routine coronary angiography in patients with non-anterior STEMI is non-inferior to primary PCI.

METHODS

Consecutive patients with non-anterior STEMI presenting within 6 hours of symptom onset who received reperfusion treatment were included. Mortality, infarct size, and in-hospital and long-term major adverse events were compared between patients treated with primary PCI to those who received thrombolysis followed by coronary angiography and intervention as needed.

RESULTS

A total of 300 patients were included: 180 who received thrombolysis and 120 treated with primary PCI. No significant differences were found in mortality, infarct size, or long-term adverse events between groups. Higher rates of in-hospital recurrent ischemic events and longer hospitalization were noted in the thrombolysis group.

CONCLUSIONS

The strategy of thrombolysis followed by routine coronary angiography in non-anterior STEMI patients results in major outcomes similar to primary PCI. Thrombolysis serves as a viable approach for patients presenting with non-anterior STEMI to hospitals without catheterization facilities. The optimal time between thrombolysis and coronary angiography should be within 2 days to avoid recurrent ischemia.