Sultan El-Zahraa M, Rabea Hoda M, Abdelmeguid Khaled R, Mahmoud Hesham B
Clinical Pharmacist, Cardiovascular Department, Beni-Suef Hospital University, Egypt.
Clinical Pharmacy Department, Faculty of Pharmacy, Beni-Suef University, Beni-Suef, Egypt.
Egypt Heart J. 2018 Mar;70(1):1-7. doi: 10.1016/j.ehj.2017.04.001. Epub 2017 Jun 12.
The purpose of the study was to investigate the safety and efficacy of transradial artery approach (TRA) in STEMI patients who reperfused early (≤3 h from symptoms onset) or late (>3 h from symptoms onset) by either PPCI or pharmaco-invasive strategy (PI), thrombolysis followed by CA. Therefore, a total 143 STEMI patients (who were presented within 12 h from symptoms onset or 12-24 h with an evidence of ongoing ischemia or suffered from an acute STEMI were randomized for either PI or PPCI. Eighty-two patients were assigned to PI arm while the rest assigned were to PPCI arm. Patients who were taken to a non-PCI capable hospital received streptokinase and were then transferred to our Hospital for CA. TRA was used in the catheterization laboratory for all patients. Each arm was divided according to reperfusion time into early and late subgroups. A primary endpoint was death, shock, congestive heart failure, or reinfarction up to 30 days. There was a non-significant difference regarding LVEF in both arms. Myocardium wall preservation was significant in the early PI arm ( = 0.023). TIMI flow had no discrepancy between both arms ( = 0.569). Mean procedural and fluoroscopic time were 35.1 ± 6.1 and 6.3 ± 0.9 min. There were no reported entry site complications. There was no difference in primary endpoint complications ( = 0.326) considering the different times of patients' reperfusion (early; = 0.696 vs. late; = 0.424). In conclusion, it is safe and effective to use TRA in STEMI patients who reperfused by either early or late PPCI or PI. We recommend PI for STEMI patients with delay presentation if PPCI is not available.
本研究的目的是调查经桡动脉途径（TRA）在通过直接经皮冠状动脉介入治疗（PPCI）或药物介入策略（PI）、溶栓后冠状动脉造影（CA）实现早期（症状发作后≤3小时）或晚期（症状发作后>3小时）再灌注的ST段抬高型心肌梗死（STEMI）患者中的安全性和有效性。因此，总共143例STEMI患者（症状发作后12小时内就诊或12 - 24小时有持续缺血证据或患有急性STEMI）被随机分为PI组或PPCI组。82例患者被分配到PI组，其余患者被分配到PPCI组。被送往无PCI能力医院的患者接受链激酶治疗，然后转至我院进行CA。所有患者在导管室均采用TRA。每组根据再灌注时间分为早期和晚期亚组。主要终点是30天内的死亡、休克、充血性心力衰竭或再梗死。两组在左心室射血分数方面无显著差异。早期PI组心肌壁保存显著（P = 0.023）。两组之间TIMI血流无差异（P = 0.569）。平均手术时间和透视时间分别为35.1±6.1分钟和6.3±0.9分钟。未报告穿刺部位并发症。考虑到患者不同的再灌注时间（早期；P = 0.696 vs. 晚期；P = 0.424），主要终点并发症无差异（P = 0.326）。总之，在通过早期或晚期PPCI或PI实现再灌注的STEMI患者中使用TRA是安全有效的。如果无法进行PPCI，我们建议对延迟就诊的STEMI患者采用PI。
