Comparative Study of Major Complication within 72 hours in Rayong Province Patients with ST-segment Elevate-Acute Coronary Syndrome in Pharmacoinvasive Strategy and Primary PCI Strategy
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Abstract
BACKGROUND: Rayong province has a high in-hospital mortality rate for patients with ST-segment Elevation Acute Coronary Syndrome (STE-ACS), reaching 15–20%, primarily due to treatment delays. While the Pharmacoinvasive Strategy allows earlier thrombolytic therapy administration, it is still associated with higher complication rates than the Primary PCI Strategy.
Thaiclinicaltrials.org number, TCTR20250515005
OBJECTIVE: To investigate the incidence of adverse events within 72 hours among STE-ACS patients in Rayong Province by comparing outcomes between those treated with a Pharmacoinvasive Strategy and those treated with a Primary PCI Strategy.
METHODS: This retrospective experimental study analyzed data from patients treated between 2019 and 2023. Participants were categorized into the Pharmacoinvasive Strategy group (n=230) and the Primary PCI Strategy group (n=432). Data on complications and patient transfer times, including Door-to-Wire Crossing and Total Ischemic Time, were analyzed. Descriptive statistics (mean, standard deviation, median, interquartile range, minimum, and maximum values) and inferential statistics (Chi-square test, Independent t-test, Mann-Whitney U test, and Cox Regression) were utilized.
RESULTS: The Primary PCI Strategy group had a lower in-hospital mortality rate (9.5%) compared to the Pharmacoinvasive Strategy group (16.5%) (p<0.05). The incidence of cardiac arrest and arrhythmias was also lower in the Primary PCI group. The Emergency Medical Services (EMS) system in Rayong province played a crucial role in reducing total ischemic time. The mean Door-to-Wire crossing time in the Primary PCI group was 1 hour and 37 minutes, shorter than the 1 hour and 44 minutes observed in the Pharmacoinvasive group (p=0.047).
CONCLUSIONS: The Primary PCI Strategy improves treatment outcomes by reducing mortality rates and other complications. Additionally, EMS in Rayong province plays a crucial role in lowering Total Ischemic Time and enhancing the efficiency of patient transfer.
Thaiclinicaltrials.org number, TCTR20250515005
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References
Health Data Center. Standard report [Internet]. 2023 [cited 2024 May 6]. Available from: https://hdc.moph.go.th/ryg/public/standard-report
Fazel R, Joseph TI, Sankardas MA, Pinto DS, Yeh RW, Kumbhani DJ, et al. comparison of reperfusion strategies for ST-segment-elevation myocardial infarction: a multivariate network meta-analysis. J Am Heart Assoc [Internet]. 2020 [cited 2025 Jan 29];9(12):e015186. Available from: https://pmc.ncbi.nlm.nih.gov/articles/PMC7429064/pdf/JAH3-9-e015186.pdf
Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). J Am Coll Cardiol 2004;44:671-719.
Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44:3720-826.
Timmer JR, Breet N, Svilaas T, Haaksma J, Van Gelder IC, Zijlstra F. Predictors of ventricular tachyarrhythmia in high-risk myocardial infarction patients treated with primary coronary intervention. Neth Heart J 2010;18:122-8.
Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK investigators. should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med 1999;341:625-34.
Arbel Y, Ko DT, Yan AT, Cantor WJ, Bagai A, Koh M, et al. Long-term follow-up of the trial of routine angioplasty and stenting after fibrinolysis to enhance reperfusion in acute myocardial infarction (TRANSFER-AMI). Can J Cardiol 2018;34:736-43.
Mehta RH, Starr AZ, Lopes RD, Hochman JS, Widimsky P, Pieper KS, et al. Incidence of and outcomes associated with ventricular tachycardia or fibrillation in patients undergoing primary percutaneous coronary intervention. JAMA 2009;301:1779-89.
Cricri P, Trachsel LD, Müller P, Wäckerlin A, Reinhart WH, Bonetti PO. Incidence and time frame of life-threatening arrhythmias in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Swiss Med Wkly [Internet]. 2012 [cited 2025 Jan 29];142:w13604. Available from: https://smw.ch/index.php/smw/article/view/1499/1882
Neyra JA, Shah S, Mooney R, Jacobsen G, Yee J, Novak JE. Contrast-induced acute kidney injury following coronary angiography: a cohort study of hospitalized patients with or without chronic kidney disease. Nephrol Dial Transplant 2013;28:1463-71.
International Guidelines Center. ST-elevation myocardial infarction (STEMI) [Internet]. 2012 [cited 2025 May 15]. Available from: https://eguideline.guidelinecentral.com/i/104088-st-elevation-myocardial-infarction/3
Gershlick AH, Stephens-Lloyd A, Hughes S, Abrams KR, Stevens SE, Uren NG, et al. Rescue angioplasty after failed thrombolytic therapy for acute myocardial infarction. N Engl J Med 2005;353:2758-68.
Alex AG, Lahiri A, Devika, Geevar T, George OK. Observational study comparing pharmacoinvasive strategy with primary percutaneous coronary intervention in patients presenting with ST elevation myocardial infarction to a tertiary care centre in India. J Postgrad Med 2018;64:80-5.
Cantor WJ, Fitchett D, Borgundvaag B, Ducas J, Heffernan M, Cohen EA, et al. Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med 2009;360:2705-18.
Krejcie RV, Morgan DW. Determining sample size for research activities. Educ Psychol Meas 1970;30:607-10.
