Department of Cardiovascular Medicine, Faculty of Medicine, Tanta University, EG.
Glob Heart. 2020 Apr 16;15(1):34. doi: 10.5334/gh.794.
Pharmacoinvasive strategy (PIS) is the alternative approach to primary percutaneous coronary intervention (PCI) if PCI capable center isn't available especially in the developing countries. Our objective of the current study was to investigate the incidence of contrast induced nephropathy (CIN), the occurrence of no reflow phenomenon and major adverse cardiac events (MACE) in patients with decreased estimated glomerular filtration rate (e-GFR) after successful fibrinolytic therapy in order to assess the benefit from very early PCI strategy (within 3-12 hours) or early PCI strategy (within 12-24 hours).
This randomized clinical trial included 420 patients with STEMI. All participants were classified randomly into two groups according to the time of intervention; Group I patients were subjected to very early PCI (within 3-12 hours) and Group II patients were subjected to early PCI (within 12-24 hours) after receiving successful fibrinolytic therapy.
The incidence of CIN in Group I was slightly higher than Group II (23 patients [10.7%] versus 19 patients [9.3%]) respectively, with no statistically significant difference between the two groups (P value = 0.625). The incidence of no-reflow phenomenon (TIMI 0-2 flow) after the procedure was higher in Group II, while TIMI 3 flow (normal flow) was significantly higher in Group I than Group II (184 [85.6%] vs. 153 [74.6%], respectively) with P value = 0.044. There was no statistically significant difference between the two groups regarding mortality and MACE.
The incidence of CIN was nearly equal in very early PCI (within 3-12 hours) versus early PCI (within 12-24 hours); however, the incidence of no-reflow phenomenon was significantly higher in patients subjected to early PCI (within 12-24 hours).
如果没有可进行经皮冠状动脉介入治疗（PCI）的中心，尤其是在发展中国家，那么药物侵入性策略（PIS）是替代的方法。我们目前的研究目的是评估在成功溶栓治疗后肾小球滤过率（e-GFR）降低的患者中，早期 PCI 策略（3-12 小时内）或即刻 PCI 策略（12-24 小时内）的对比剂肾病（CIN）发生率、无复流现象的发生和主要不良心脏事件（MACE）。
这是一项随机临床试验，纳入了 420 例 ST 段抬高型心肌梗死患者。所有患者根据干预时间随机分为两组；I 组患者接受早期 PCI（3-12 小时内），II 组患者接受即刻 PCI（12-24 小时内）。
I 组的 CIN 发生率略高于 II 组（分别为 23 例[10.7%]和 19 例[9.3%]），但两组间无统计学差异（P 值=0.625）。术后 II 组无复流现象（TIMI 0-2 级血流）发生率较高，而 I 组 TIMI 3 级血流（正常血流）明显高于 II 组（分别为 184 例[85.6%]和 153 例[74.6%]），P 值=0.044。两组死亡率和 MACE 无统计学差异。
早期 PCI（3-12 小时内）与即刻 PCI（12-24 小时内）的 CIN 发生率几乎相等；然而，早期 PCI（12-24 小时内）患者无复流现象发生率明显更高。
