Background: Randomized trials and meta-analyses have shown the superiority of primary percutaneous intervention (PPCI) over in-hospital thrombolysis in restoring vessel patency, conserving ventricular function and improving clinical outcome in STEMI patients. The advantage of PPCI was mostly evident in high-risk patients treated within 6-12 hours from symptom onset while most thrombolytically-treated patients in these studies did not undergo angiography at all.
Methods: We studied in the current retrospective analysis 5474 STEMI patients, included in the biannual Acute Coronary Syndrome Israeli Surveys (ACSIS) conducted from 2000 to 2010. Of these, 1464 hemodynamically-stable STEMI patients treated within 3 hours from symptom onset, comprised the study population: 899 patients who underwent PPCI, 383 that received in-hospital thrombolysis followed by angiography during index hospitalization (TFA), while 182 were treated by thrombolysis only (TO).
Results: The median time from symptom onset to admission was 110, 105 and 120 minutes for PPCI, TFA and TO, respectively (p=0.4 for all and 0.08 for PPCI vs. TFA). The Median time from arrival to reperfusion was 63, 45 and 52.5 minutes for PPCI, TFA and TO, respectively (p<0.001 for all). The composite end-point of 30-d death, re-infarction and post-infarction angina was significantly higher in the thrombolytically treated patients [PPCI 77 (8.6%), TFA 64 (16.7%) and TO 36 (19.8%), (p<0.001)]. The difference was driven by the higher incidence of post-infarction angina in the thrombolysis-treated patients. We found no difference in the 1-year mortality: PPCI 27 (3%), TFA 13 (3.4%) and TO 11 (6.1%), (p=NS).
Conclusion: No one-year survival benefit for PPCI over thrombolysis was observed in stable early-arriving STEMI patients. The difference in composite end-point was driven by increased incidence of post-infarction angina in thrombolytically-treated patients.
