Abstract / Summary
This cross sectional analytical study was aimed to compare the in-hospital outcome (changes in LVEF, TIMI flow after PCI, major bleeding, acute stroke, mortality, re-infarction, hypotension, cardiogenic shock and arrhythmia) of pharmacoinvasive strategy versus pPCI in STEMI patients. This study was conducted in Ibrahim Cardiac Hospital and Research Institute (ICHRI), Dhaka, Bangladesh from January 2020 to June 2022; to compare the in-hospital outcome of pharmacoinvasive strategy using Tenecteplase with that of pPCI in the management of patients with STEMI. The study included a total of 100 cases of STEMI - randomized to pPCI (n=50) and pharmacoinvasive strategy (n=50). The in-hospital outcome (efficacy and safety) of the two strategies were studied, where efficacy was determined in terms of positive outcome (changes in LVEF and TIMI flow after PCI) and complications (death, re-infarction, acute stroke, hypotension, major episode of bleeding, cardiogenic shock and arrhythmia) experienced by the two groups. The mean age of the pPCI group was 52.9 years and that of pharmacoinvasive group was 56.2 years (p=0.139). Males were predominant in both the study groups; however, males were considerably higher in the pPCI group than that in the pharmacoinvasive group (p=0.054). Although insignificant changes in LVEF and TIMI grade flow (TIMI; p=0.380) between two groups but significant changes of LVEF and TIMI flow were observed in individual group in respect to pre and post PCI (LVEF; pPCI= 0.004 PhI, p=0.005 and TIMI flow; pPCI=0.005, PhI, p=0.004). The distributions of risk factors were almost alike between the two study groups. However, DVD and TVD were significantly higher in pharmacoinvasive group than those in the pPCI group (p=0.010). As outcome was compared between groups, the incidences of death (6.0%) and stroke (8.5%) were observed in pharmacoinvasive group alone. The incidence of hypotension was much higher in the pharmacoinvasive group (42.5%) than that in the pPCI group (16.0%) (p=0.004). Major bleeding episode was much higher in the pharmacoinvasive group (8.5%) than that in the pPCI group (2.0%) (p= 0.162). While pPCI receiving STEMI patients regain nearly full-patency of the culprit vessel. Almost similar result observed in patients received pharmacoinvasive strategy. However; small proportions of patients in pharmacoinvasive strategy cause stroke which may be fatal. Hypotension and major bleeding are also common in pharmacoinvasive strategy than that in pPCI strategy. The pPCI is preferred to pharmacoinvasive strategy if STEMI patients present themselves early in PCI-capable center. However, pharmacoinvasive strategy is a reasonable alternative for patients where pPCI could not be done within the recommended time.
Primary Source
Mymensingh medical journal : MMJ
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