The Impact of Admission Pathway and Reperfusion Modality on Long-term Mortality in STEMI patients

Primary percutaneous coronary intervention (PPCI) is therapy of choice for ST-elevation myocardial infarction (STEMI) with thrombolysis falling out of favor. However, studies have shown efficacy for early-administered thrombolysis to uncomplicated patients.

At our center STEMI patients are treated by thrombolysis if stable and present

Study population included 1014 consecutive patients with STEMI (median age-58, range-25-95) treated between 6/2008-11/2014 by PPCI (n=454) or the pharmacoinvasive strategy (n=256). The other received no immediate reperfusion therapy but underwent angiography early during admission. Registry included 831 male (82%), 360 Arab (36%) patients, while 595 (59%), 379 (36.6%), 251 (25%), 231 (23%), and 57 (5.6%) were hypertensive, diabetic, or after a coronary angioplasty, an AMI, or a stroke, respectively. Guideline-dictated time intervals was achieved in 84% for PPCI and 65% for thrombolysis with direct admission to the CCU, while attained in only in 32% and 14% when admitted via the ED. The median 3.5-year mortality (3.6±1.6 years) was 8.4% and 16.6% for direct admission vs. admission via ED (p=0.001). Long-term survival of patients treated by thrombolysis, PPCI, or with no immediate reperfusion was 95.3%, 88.7%, and 84.5%, respectively (p

Direct admission of STEMI patients expedited admission and improved long-term outcome regardless of reperfusion strategy and seems almost mandatory if guideline-dictated time constraints are to be attained. The pharmacoinvasive strategy yielded excellent results, and could be applied at centers without on-site 24/7 PPCI service.