Levi Yaniv, Frimerman Aaron, Shotan Avraham, Shochat Michael, Blondheim David S, Segev Amit, Goldenerg Ilan, Kazatsker Mark, Vasilenko Liubov, Shlomo Nir, Meisel Simcha R
Heart Institute, Hillel Yaffe Medical Center, Hadera, Israel.
Heart Institute, Leviev Heart Center, Sheba Medical Center, Tel Hashomer, Israel.
Isr Med Assoc J. 2017 Jun;19(6):345-350.
Trials have shown superiority of primary percutaneous intervention (PPCI) over in-hospital thrombolysis in ST-elevation myocardial infarction (STEMI) patients treated within 6-12 hours from symptom onset. These studies also included high-risk patients not all of whom underwent a therapeutic intervention.
To compare the outcome of early-arriving stable STEMI patients treated by thrombolysis with or without coronary angiography to the outcome of PPCI-treated STEMI patients.
Based on six biannual Acute Coronary Syndrome Israeli Surveys comprising 5474 STEMI patients, we analyzed the outcome of 1464 hemodynamically stable STEMI patients treated within 3 hours of onset. Of these, 899 patients underwent PPCI, 383 received in-hospital thrombolysis followed by angiography (TFA), and 182 were treated by thrombolysis only.
Median time intervals from symptom onset to admission were similar while door-to-reperfusion intervals were 63, 45 and 52.5 minutes for PPCI, TFA and thrombolysis only, respectively (P < 0.001). The 30-day composite endpoint of death, post-infarction angina and myocardial infarction occurred in 77 patients of the PPCI group (8.6%), 64 patients treated by TFA (16.7%), and 36 patients of the thrombolysis only group (19.8%, P < 0.001), with differences mostly due to post-infarction angina. One-year mortality rate was 27 (3%), 13 (3.4%) and 11 (6.1%) for PPCI, TFA and thrombolysis only, respectively (P = 0.12).
PPCI was superior to thrombolysis in early-arriving stable STEMI patients with regard to 30-day composite endpoint driven by a decreased incidence of post-infarction angina. No 1 year survival benefit for PPCI over thrombolysis was observed in early-arriving stable STEMI patients.
试验表明，对于症状发作后6至12小时内接受治疗的ST段抬高型心肌梗死（STEMI）患者，直接经皮冠状动脉介入治疗（PPCI）优于院内溶栓治疗。这些研究还纳入了高危患者，并非所有患者都接受了治疗性干预。
比较早期到达的稳定型STEMI患者接受溶栓治疗（无论是否进行冠状动脉造影）与接受PPCI治疗的STEMI患者的结局。
基于六项半年期的以色列急性冠状动脉综合征调查，共纳入5474例STEMI患者，我们分析了1464例在症状发作后3小时内接受治疗的血流动力学稳定的STEMI患者的结局。其中，899例患者接受了PPCI，383例接受了院内溶栓治疗后行血管造影（TFA），182例仅接受了溶栓治疗。
从症状发作到入院的中位时间间隔相似，而PPCI、TFA和仅溶栓治疗的门至再灌注时间间隔分别为63、45和52.5分钟（P<0.001）。PPCI组77例患者（8.6%）、TFA治疗组64例患者（16.7%）和仅溶栓治疗组36例患者（19.8%）发生了30天综合终点事件，即死亡、梗死后心绞痛和心肌梗死，差异主要归因于梗死后心绞痛。PPCI组、TFA组和仅溶栓治疗组的1年死亡率分别为27例（3%）、13例（3.4%）和11例（6.1%）（P=0.12）。
对于早期到达的稳定型STEMI患者，PPCI在30天综合终点方面优于溶栓治疗，这是由于梗死后心绞痛的发生率降低。在早期到达的稳定型STEMI患者中，未观察到PPCI比溶栓治疗有1年生存获益。
