Pharmacoinvasive strategy as reperfusion treatment in non-capable primary percutaneous coronary intervention areas

• Published in: REC, Interventional cardiology (Internet. English ed.) Vol. 2; no. 3; pp. 175 - 182
• Main Authors: Nieto Tolosa, José, Cambronero, Francisco, A. Hurtado, José, Bru, Mariano, Gómez-Sánchez, Diego, Sánchez-Cámara, Silvia, Mateo, Alicia, Pérez-Flores, Ernesto, de Lara, Juan García, Sánchez-Galián, M. José, R. Gimeno, Juan, Lacunza, Javier, la Parte, José I. Pascual de, Leithold, Gunnar, García-Córdoba, Francisco, Rodríguez, Pascual, Galcerá, José, Jara, Rubén, Pinar Bermúdez, Eduardo
• Format: Journal Article
• Language: English
• Published: Permanyer 01.07.2020
• Subjects: Fibrinolysis; Primary percutaneous coronary intervention; Reperfusion therapy; ST-segment elevation acute coronary syndrome
• ISSN: 2604-7322; 2604-7322
• DOI: 10.24875/RECICE.M20000113

ABSTRACT Introduction and objectives: Reperfusion therapy during an ST-segment elevation acute coronary syndrome (STEACS) can be performed using fibrinolytic agents or primary percutaneous coronary intervention (pPCI). The pPCI is the reperfusion strategy of choice, but many patients with STEACS initially come to non-PCI capable hospitals. Regional networks have been launched with both reperfusion therapies using thrombolysis in indicated cases followed by routine angiographic studies (pharmacoinvasive strategy). Our objective was to analyze the results of treatment in patients with STEACS in the Region of Murcia, Spain based on the patient’s place of ​​origin. Methods: Retrospective study of a cohort of patients admitted due to STEACS to 3 health areas: pPCI-capable Area 1 (Hospital Clínico Universitario Virgen de la Arrixaca), and non-pPCI capable Areas IV and V (Hospital Comarcal del Noroeste, Caravaca de la Cruz, and Virgen del Castillo, Yecla). Results: Six hundred and seventy-nine patients from health areas I, IV, and V of the Region of Murcia were treated of STEACS from 2006 through 2010. Out of the 494 patients from Area I, 97.6% (482 patients) were treated with pPCI while 2.4% (12 cases) received thrombolysis. In Areas IV and V, 73% (135) of patients were treated with pPCI and 27% (50) with thrombolysis. After thrombolysis, 46 patients (34%) required rescue angioplasty and 79 (58.5%) underwent a scheduled coronary angiography (pharmacoinvasive strategy). No statistically significant differences were reported in the overall mortality rate at 30-day (8.3% in Area I vs 6% in Areas IV and V; P = .31) or 1 year follow-up (11.3% vs 8.2%; P = .23) in Area I compared to Areas IV and V, nor for cardiac mortality. Conclusions: Although immediate pPCIs are less accessible in remote health areas, the healthcare network from the Region of Murcia can achieve similar mortality results compared to populations with pPCI availability.