ST-segment elevation myocardial infarction for pharmacoinvasive strategy or primary percutaneous coronary intervention in Gaza (STEPP 2- PCI) trial.

INTRODUCTION

Primary percutaneous coronary intervention (P-PCI) is still preferred as the optimal reperfusion therapy among patients with ST-segment elevation myocardial infarction (STEMI). However, in non-PCI capable hospitals, pharmacoinvasive treatment (Ph-PCI) can be performed as alternative therapy to P-PCI. This study compares the efficacy between a Ph-PCI and P-PCI strategies among patients with STEMI.

MATERIAL AND METHODS

We conducted a retrospective analysis of patients with STEMI presenting within 12 h of symptoms onset assigned to two groups: Group 1 ( = 154 patients) - P-PCI within 90 min after first medical contact; Group 2 ( = 154 patients) - Ph-PCI 2-24 h after completion of thrombolytic treatment in the emergency room at Alshifa Hospital in Gaza. Primary endpoint: a composite of heart failure and total death at 30 days. Secondary endpoint: the percentage resolution of ST-segment elevation 60 min after PCI.

RESULTS

In total, 308 patients presented with acute STEMI (≤ 12 h from symptom onset to first medical contact), mean age 58.05 ±11.3 years; 257 (83.5%) patients were male. The primary endpoint in P-PCI was observed in 16.2% and in Ph-PCI 8.4%; = 0.038. There was no difference in 30-day total death (5.2% in P-PCI and 3.2% in Ph-PCI), = 0.39, no difference in heart failure (11% in P-PCI and 5.2% in Ph-PCI), = 0.06. Secondary endpoint: after PCI sum ST-elevation resolution more than 50%, was seen in 65% in patients in P-PCI group and 76.2% in patients in Ph-PCI group; = 0.034.

CONCLUSIONS

Ph-PCI was associated with decreased composite endpoints of mortality and heart failure outcomes during 30 days after STEMI and improved ST-segment resolution within 1 h after percutaneous coronary intervention.