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RESEARCH PRODUCT
Five-year outcomes following timely primary percutaneous intervention, late primary percutaneous intervention, or a pharmaco-invasive strategy in ST-segment elevation myocardial infarction: the FAST-MI programme
Patrick GoldsteinFast-mi InvestigatorsEtienne PuymiratLoic BelleNicolas DanchinFrançois RoubilleJean FerrièresGuillaume CaylaFrancois SchieleGilles LemesleBatric PopovicTabassome Simonsubject
medicine.medical_specialtyPercutaneousmedicine.medical_treatment[SDV]Life Sciences [q-bio]Myocardial InfarctionAcute myocardial infarction030204 cardiovascular system & hematology03 medical and health sciencesPercutaneous Coronary Intervention0302 clinical medicineReperfusion therapyFibrinolytic Agents[SDV.MHEP.CSC]Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular systemFibrinolysismedicineHumansST segment030212 general & internal medicineMyocardial infarctioncardiovascular diseasesTimingPrimary PCIbusiness.industryFibrinolysisHazard ratioPercutaneous coronary interventionmedicine.diseaseLong-term outcome3. Good health[SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system[SDV] Life Sciences [q-bio]Treatment OutcomeEmergency medicineConventional PCIST Elevation Myocardial InfarctionCardiology and Cardiovascular Medicinebusinessdescription
Abstract Aims ST-segment elevation myocardial infarction (STEMI) guidelines recommend primary percutaneous coronary intervention (pPCI) as the default reperfusion strategy when feasible ≤120 min of diagnostic ECG, and a pharmaco-invasive strategy otherwise. There is, however, a lack of direct evidence to support the guidelines, and in real-world situations, pPCI is often performed beyond recommended timelines. To assess 5-year outcomes according to timing of pPCI (timely vs. late) compared with a pharmaco-invasive strategy (fibrinolysis with referral to PCI centre). Methods and results The French registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction (FAST-MI) programme consists of nationwide observational surveys consecutively recruiting patients admitted for acute myocardial infarction every 5 years. Among the 4250 STEMI patients in the 2005 and 2010 cohorts, those with reperfusion therapy and onset-to-first call time <12 h (n = 2942) were included. Outcomes at 5 years were compared according to type of reperfusion strategy and timing of pPCI, using Cox multivariable analyses and propensity score matching. Among those, 1288 (54%) patients had timely pPCI (≤120 min from ECG), 830 (28%) late pPCI (>120 min), and 824 (28%) intravenous fibrinolysis. Five-year survival was higher with a pharmaco-invasive strategy (89.8%) compared with late pPCI [79.5%; adjusted hazard ratio (HR) 1.51; 1.13–2.02] and similar to timely pPCI (88.2%, adjusted HR 1.02; 0.75–1.38). Concordant results were observed in propensity score-matched cohorts and for event-free survival. Conclusion A substantial proportion of patients have pPCI beyond recommended timelines. As foreseen by the guidelines, these patients have poorer 5-year outcomes, compared with a pharmaco-invasive strategy.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2019-09-20 |