Author + information
- David Larson1,
- Ross Garberich2,
- Daniel Lips2,
- M. Nicholas Burke2,
- Ivan Chavez2,
- Scott Sharkey2,
- Claire Donovan2 and
- Timothy Henry3
Current ACCF/AHA guidelines recommend fibrinolysis (FL) as the preferred reperfusion strategy for STEMI pts with expected delays of > 120 minutes from first medical contact to PCI followed by transfer to a PCI center with angiography/PCI within 3-24 hrs. Assessment of reperfusion prior to angiography my not be accurate based on clinical and ECG criteria alone and recent data suggested increased recurrent ischemic events within the first 24 hrs. The aim of this study is to assess the safety of very early PCI (< 3 hours) following FL.
The Minneapolis Heart Institute Level 1 MI program is a regional STEMI system with a standardized protocol where pts transferred from spoke hospitals with expected delays of > 120 mins to PCI receive a pharmacoinvasive (PI) therapy: half-dose FL, UFH, ASA and Clopidogrel with transfer for immediate PCI. Prospective registry data from the Level 1 database was analyzed to compare clinical outcomes related to the timing of PCI following FL: <60, 61-90, 91-120, 121-180, >180 min. Pts transferred for PCI alone were available for comparison.
From 01/03 to 12/15, 3453 STEMI pts were transferred from spoke hospitals for immediate PCI inducing 869 receiving FL. Pre-PCI IMI 2/3 flow occurred in 71%. The majority of PI pts underwent PCI 61-90 (47%) or 91-120 (28%) mins post-FL. Key clinical, time-to-treatment and outcomes are included in Table. There were no significant differences in mortality, bleeding, reinfarction or stroke related to timing of PCI between these 5 groups.
Very early PCI (< 3hrs) following FL in pts with expected delays to PCI is safe without increased MACE. Delaying angiography for 3-24 hrs following FL may not be necessary and may result in delays to reperfusion in pts who fail to reperfuse, as well as increased recurrent ischemia and length of stay.
CORONARY: Acute Myocardial Infarction