From the Cardiology Department, Beni-Suef University Hospital, Beni-Suef, Egypt.
Pharmacology Department, Faculty of Medicine, Beni-Suef University Hospital, Beni-Suef, Egypt.
Crit Pathw Cardiol. 2021 Sep 1;20(3):149-154. doi: 10.1097/HPC.0000000000000250.
Fibrin-specific fibrinolytics are preferred when they used in STEMI patients (pharmaco-invasive approach). However, streptokinase is still the most common used thrombolytic agent in Egypt because of its cheaper cost.
266 STEMI patients were randomly assigned to undergo PPCI or pharmacoinvasive (using streptokinase). Primary end point (death, shock, congestive heart failure, or reinfarction up to 30 d) and secondary end point (ischemic stroke, intracranial hemorrhage, or nonintracranial bleeding) were followed for 30 days after reperfusion. In pharmaco-invasive arm, urgent coronary angiography was performed in case of failed reperfusion. Based on the reperfusion time from symptoms onset, patients in both arms were divided into; early (≤3 hrs) and late reperfusion (>3 hrs).
No statistical significant difference regarding left ventricular ejection fraction, end diastolic and end systolic diameter in both arms. Early PPCI (≤3 hrs) had highest ejection fraction values (56.9 ± 7.5). Myocardial wall preservation was best achieved in early pharmaco-invasive (≤3 hrs).There was no statistical significant difference in TIMI flow results between all subgroups (early and late of both arms) (P = 0.750). Suction devices and IV Eptifibatide were less frequently used in the pharmaco-invasive comparing to PPCI arm; (P = 0.000 and P = 0.006) subsequently. No statistical significant difference regarding complication incidence in both arms (P = 0.518). Radial access was more commonly used in the pharmaco-invasive arm (P = 0.015).
Utilizing streptokinase in early re-perfused patients by PI approach (≤3 hrs) seems safe and efficient when PPCI delay (>120 min from symptom onset) is the other option.
在 STEMI 患者中（药物介入治疗策略），当使用纤维蛋白特异性纤维蛋白溶解剂时，它们是首选。然而，由于其成本较低，链激酶仍然是埃及最常用的溶栓剂。
266 例 STEMI 患者被随机分配接受 PPCI 或药物介入（使用链激酶）治疗。主要终点（死亡、休克、充血性心力衰竭或 30 天内再梗死）和次要终点（缺血性卒中和颅内出血或非颅内出血）在再灌注后 30 天内进行随访。在药物介入组，如果再灌注失败，则进行紧急冠状动脉造影。根据症状发作至再灌注时间，将两组患者分为早期（≤3 小时）和晚期（>3 小时）。
两组患者的左心室射血分数、舒张末期和收缩末期直径均无统计学差异。早期 PPCI（≤3 小时）的射血分数值最高（56.9±7.5）。早期药物介入（≤3 小时）心肌壁保存最好。两组所有亚组（早期和晚期）的 TIMI 血流结果均无统计学差异（P=0.750）。与 PPCI 组相比，药物介入组较少使用抽吸装置和静脉依替巴肽（P=0.000 和 P=0.006）。两组患者的并发症发生率无统计学差异（P=0.518）。药物介入组更常使用桡动脉入路（P=0.015）。
当 PPCI 延迟（症状发作后>120 分钟）是另一种选择时，在 PI 方法下（≤3 小时）早期再灌注患者中使用链激酶似乎是安全有效的。
