Volume 31, Issue 144 (January & February 2023)                   J Adv Med Biomed Res 2023, 31(144): 32-39 | Back to browse issues page

XML Print

Download citation:
BibTeX | RIS | EndNote | Medlars | ProCite | Reference Manager | RefWorks
Send citation to:
Gharanjik S, Motedayen M, Hasanzadeh Makoui R, Motamed N, Emami M, Bordbar A, et al . Comparison of the Success Rate of Treatment with Primary Percutaneous Coronary Intervention PCI versus Thrombolytic Treatment in Patients with ST-Elevation Myocardial Infarction in Local Hospitals in Iran. J Adv Med Biomed Res 2023; 31 (144) :32-39
URL: http://journal.zums.ac.ir/article-1-5703-en.html
Comparison of the Success Rate of Treatment with Primary Percutaneous Coronary Intervention PCI versus Thrombolytic Treatment in Patients with ST-Elevation Myocardial Infarction in Local Hospitals in Iran
Soleiman Gharanjik1 , Morteza Motedayen2 , Reza Hasanzadeh Makoui1 , Nima Motamed3 , Minoo Emami3 , Armin Bordbar1 , Mohammad Reza Jamshidi4 , Reza Madadi *5
1- Dept. of Cardiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
2- Dept.of Cardiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
3- School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
4- Dept. of Cardiac Anesthesiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran
5- Dept. of Cardiology, School of Medicine, Zanjan University of Medical Sciences, Zanjan, Iran , drrezamadadi@zums.ac.ir
Abstract:   (11513 Views)

Background and Objective: Acute myocardial infarction (MI) is caused due to coronary artery occlusion and divided into two forms of ST-elevation (STEMI) and non-ST-elevation (NSTEMI) myocardial infarction. This study aimed to determine the success rate of treatment with primary PCI (percutaneous coronary intervention) versus thrombolysis in the establishment of perfusion and to evaluate the short-term complications caused by each method.
Materials and Methods: In this prospective cohort study, 90 patients were selected for primary PCI treatment and 90 patients for thrombolytic treatment. Clinical data and basic demographic characteristics of the patients and cardiovascular risk factors were recorded. The success rate of coronary reperfusion by primary PCI and thrombolytic therapy was then determined by angiography and 90-minute ECG with resolution or improvement of chest pain. All patients were examined for any serious complications such as cerebrovascular accidents, shock, and heart failure for 30 days after treatment. Data were analyzed using SPSS ver. 20.
Results: In the primary PCI group, 75.6% of the patients were males, and 24.4% were females, but in the thrombolytic group, 76.6% and 23.3% of the cases were males and females, respectively. The mean door-to-balloon time for PCI was 63.60 ± 23.92 and was 53.70 ±21.52 min in the thrombolytic group. Thrombolysis in myocardial infarction (TIMI) flow grade III and TIMI-II were the most frequent in primary PCI and thrombolytic groups, respectively. The odds ratio (OD) of mechanical MI and major arrhythmia in patients received the primary PCI compared to those received thrombolytic therapy was 0.24 and 0.66, respectively. Also, the OD of mortality in the primary PCI group was 2.12.
Conclusion: Our findings suggest that in STEMI patients, the chances of short-term complications such as post-MI mechanical complications, major arrhythmia, and bleeding requiring blood transfusion were lower in patients who were treated with primary PCI than those who received thrombolytic treatment. Also, the average hospitalization in CCU and hospital in the primary PCI group was lower than the thrombolytic group.

Keywords: Primary PCI, Thrombolytic, Fibrinolysis, ST-Elevation Myocardial Infarction (STEMI)
Full-Text [PDF 545 kb]   (10740 Downloads) |   |   Full-Text (HTML)  (1005 Views)  

✅ Our findings suggest that in STEMI patients, the chances of short-term complications such as post-MI mechanical complications, major arrhythmia, and bleeding requiring blood transfusion were lower in patients who were treated with primary PCI than those who received thrombolytic treatment. Also, the average hospitalization in CCU and hospital in the primary PCI group was lower than the thrombolytic group.


Type of Study: Original Research Article | Subject: Clinical Medicine
Received: 2021/04/4 | Accepted: 2022/03/3 | Published: 2022/12/12
References
1. Shah RU, Rutten-Ramos S, Garberich R, Tighiouart M, Henry TD, Merz CNB. STEMI trends in the United States 2002-2010: increasing use of PCI and declining mortality. Circulation: Cardiovasc Qual Outcome. 2013;6(Suppl 1):A22-A. [DOI:10.1161/circoutcomes.6.suppl_1.A22]
2. Wojakowski W, Tendera M, Tubaro M, et al. Are elderly patients with acute coronary syndromes undertreated? Data from Euro Heart Survey on ACS III registry. Am J Cardiol. 2013;111(7):1B. [DOI:10.1016/j.amjcard.2013.01.004]
3. Kornowski R, Vaknin-Assa H, Dvir D, et al. The impact of intracoronary thrombus aspiration on STEMI outcomes. Cardiovasc Revascular Med. 2012;13(3):167-71. [DOI:10.1016/j.carrev.2012.01.005] [PMID]
4. Kasprzak J, Kolodziej K, Peruga J,et al. Inflammation/LIPID score may outperform TIMI score for prediction of PCI-treated STEMI outcomes. Cardiol. 2013;125:225.
5. Savonitto S, Armstrong P, Lincoff A, et al. Risk of intracranial haemorrhage with combined fibrinolytic and glycoprotein IIb/IIIa inhibitor therapy in acute myocardial infarction: dichotomous response as a function of age in the GUSTO V trial. Europ Heart J. 2003;24(20): 1807-14. [DOI:10.1016/j.ehj.2003.07.004] [PMID]
6. Larson DM, Duval S, Sharkey SW, et al. Safety and efficacy of a pharmaco-invasive reperfusion strategy in rural ST-elevation myocardial infarction patients with expected delays due to long-distance transfers. Europ Heart J. 2011;33(10):1232-40. [DOI:10.1093/eurheartj/ehr403] [PMID]
7. Halvorsen S, Huber K. The role of fibrinolysis in the era of primary percutaneous coronary intervention. Thrombos Haemostas. 2011;105(3):390. [DOI:10.1160/TH10-08-0513] [PMID]
8. Kazemi T, Sharifzadeh G, Zarban A, Fesharakinia A. Comparison of components of metabolic syndrome in premature myocardial infarction in an Iranian population: a case-control study. Int J Prevent Med. 2013;4(1):110.
9. Kouhestani HR, Baghcheghi N, ZAND S. Impact of teaching cardiac rehabilitation programs on electrocardiogram changes among patients with myocardial infraction. Iran J Nurs Res. 2010; 5(16): 6-12.
10. Taherian A, Mohammadi F, Hosseini MA, Rahgoaar M, Falahi KM. The effectiveness of patient education and home-based follow up on knowledge and health behaviors in patients with myocardial infarction. Iran J Nurs Res. 2007; 2(5-6):7-13.
11. Hamm CW, Bassand JP, Agewall S, et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). Europ Heart J. 2011;32(23):2999-3054. [DOI:10.1093/eurheartj/ehr236] [PMID]
12. Bonow RO, Mann DL, Zipes DP, Libby P. Braunwald's Heart Disease E-Book: A Textbook of Cardiovascular Medicine: Elsevier Health Sciences; 2011.
13. Kolh P, Windecker S, Alfonso F, et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Europ Heart J . 2014;46(4):517-92.
14. Ge H, Pu J, Li Z, et al. Comparison of instant thrombolysis plus early PCI and primary PCI in STEMI patients, view of CMR early after reperfusion therapy. Am J Cardiol. 2013;111(7):8B. [DOI:10.1016/j.amjcard.2013.01.025]
15. Armstrong PW, Gershlick AH, Goldstein P, et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. New Eng J Med. 2013;368(15):1379-87. [DOI:10.1056/NEJMoa1301092] [PMID]
16. Widimský P, Budešínský T, Voráč D, et al. Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Europ Heart J. 2003;24(1):94-104. [DOI:10.1016/S0195-668X(02)00468-2] [PMID]
17. Henriques JP, Zijlstra F, van't Hof AW, et al. Primary percutaneous coronary intervention versus thrombolytic treatment: long term follow up according to infarct location. Heart. 2006;92(1):75-9. [DOI:10.1136/hrt.2005.060152] [PMID] [PMCID]
18. Claeys MJ, de Meester A, Convens C, et al. Contemporary mortality differences between primary percutaneous coronary intervention and thrombolysis in ST-segment elevation myocardial infarction. Arch Internal Med. 2011;171(6):544-9. [DOI:10.1001/archinternmed.2011.57] [PMID]
19. Busk M, Maeng M, Rasmussen K, et al. The Danish multicentre randomized study of fibrinolytic therapy vs. primary angioplasty in acute myocardial infarction (the DANAMI-2 trial): outcome after 3 years follow-up. Europ Heart J. 2007; 29(10): 1259-66. [DOI:10.1093/eurheartj/ehm392] [PMID]
20. Dieker H, Brouwer M, van Horssen E, et al. Fibrinolysis and primary PCI for ST-elevation myocardial infarction: call for a more refined perspective. Netherlands Heart J. 2004;12(7-8):343.
21. Steg PG, Bonnefoy E, Chabaud S, et al. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty data from the CAPTIM randomized clinical trial. Circulation. 2003;108(23):2851-6. [DOI:10.1161/01.CIR.0000103122.10021.F2] [PMID]
Send email to the article author

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

© 2025 CC BY-NC 4.0 | Journal of Advances in Medical and Biomedical Research

Designed & Developed by : Yektaweb