Author + information
- Sang Yeub Lee,
- Sang Min Kim,
- Jang-Whan Bae and
- Kyung-Kuk Hwang
Previous data showed similar clinical outcome of reperfusion therapy by primary percutaneous coronary intervention (PPCI) versus thrombolysis in Patients with ST-Segment Elevation Myocardial Infarction (STEMI) within 3 hours of the onset of symptoms. But in drug eluting stent(DES) era and current real world practice, we have little data. The aim of the present study was to compare the clinical outcomes of patients with STEMI within 3hours of onset of symptoms according to reperfusion methods.
Between 2010 and Aug 2014, 5367 patients (4222 male; age=64.2 years) were enrolled a nationwide prospective Korea Acute Myocardial Infarction Registry (KAMIR). Clinical outcome was analyzed according to reperfusion therapy in the field of acute STEMI within 3hours of onset of symptoms.
The primary end points were cardiac death and major adverse cardiac events (MACE). A total of 5367 patients (thrombolysis 344, PPCI 5023) were enrolled. Mean follow up period was 732 day. There were no significant differences in baseline characteritics except sex and Killip class. More patients with reperfusion therapy by PPCI had Killip 3 and 4 class than thrombolysis and More male patients were enrolled in thrombolysis group. In the two thirds patients of thrombolysis group, adjunctive or rescue PCI were performed after thrombolysis. In PPCI group, 70.6 % of patients were treated with 2nd generation drug eluting stents. Only 5.6% of the patients in PPCI group were treated with bare metal stents the patients. There were no significant differences in the incidence of death and MACE at 30 days and 12 months. In survival analysis, There were no significant difference during clinical follow-up between two groups (p < 0.34). When we excluded the patients with Killip 4 class, there were also no significant differences in the incidence of end points.
In current real world practice and DES era, PPCI and thrombolysis were similar efficacy of reperfusion therapy for the patients with STEMI 3hours of onset of symptoms as well. But in the two third of patient with revascularization by thrombolysis, adjunctive or rescue PCI were performed after thrombolysis therapy.