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ȣ - 520006 38 |
| Early, Elective Percutaneous Coronary Intervention Is Safe and Beneficial After Successful Thrombolytic Therapy for Acute Myocardial Infarction |
| 대한심장학회 Korea Acute Myocardial Infarction Registry 연구자 |
| 심두선, 정명호, 안영근, 채성철, 허승호, 성인환, 김종현, 홍택종, 구본권, 채제건, 채동훈, 윤정한, 배장호, 나승운, 류제영, 김두일, 김기식, 김병옥, 오석규, 채인호, 이명용, 정경태, 조명찬, 김종진, 김영조, 외 Korea Acute Myocardial Infarction Registry Investigators |
OBJECTIVE: The aim of this study was to assess the safety and benefits of early, elective percutaneous coronary intervention (PCI) after successful thrombolytic therapy for acute myocardial infarction (MI).
BACKGROUND: Early, elective PCI after successful thrombolysis is controversial. In case an invasive route is chosen, how early a PCI should be performed still remains elusive.
METHODS: Employing data from the Korea Acute Myocardial Infarction Registry (KAMIR; November 2005 to June 2007), a total of 383 patients with acute MI who underwent elective PCI within two weeks of successful thrombolytic therapy were grouped based on time between thrombolysis and PCI: group 1: < 24 hours (N=81, 71 men, 59.5±10.5 years of age); group 2: ≥ 24 hours and < 48 hours (N=79, 72 men, 59.5±11.6 years); group 3: ≥ 48 hours and < 72 hours (N=79, 65 men, 61.0±10.8 years); group 4 > 72 hours (N=144, 109 men, 61.7±12.8 years). Primary study outcomes include major bleeding complications, in-hospital death, major adverse cardiac events (MACE: cardiac death, MI, repeat PCI, and coronary artery bypass surgery) at one, six and 12 months after the index procedure.
RESULTS: There were no differences between the four groups in the baseline clinical characteristics and angiographic findings. Symptom onset to needle time was similar between the four groups: 4.0±3.2 hours in group 1; 5.8±7.4 hours in group 2; 5.4±9.6 hours in group 3; and 4.4±4.4 hours in group 4, p=0.226. There were no differences in the incidence of major bleeding, in-hospital mortality, and one-month outcomes between the groups. The rates of composite MACE and repeat PCI at 6 and 12 months were significantly lower in patients who underwent PCI within 48 hours of thrombolytic therapy, compared with those who underwent PCI later (6-month MACE: 0.7% vs. 7.3%, p=0.005; 6-month repeat PCI: 0% vs. 5.2%, p=0.006; 12-month MACE: 2.2% vs. 8.9%, p=0.017; 12-month repeat PCI: 0.7% vs. 5.7%, p=0.017).
CONCLUSION: Early, elective PCI within 48 hours of successful thrombolytic therapy for acute MI is safe and more beneficial, compared with PCI performed later.
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