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

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, ۹۰ patients were selected for primary PCI treatment and ۹۰ 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 ۹۰-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 ۳۰ days after treatment. Data were analyzed using SPSS ver. ۲۰. Results: In the primary PCI group, ۷۵.۶% of the patients were males, and ۲۴.۴% were females, but in the thrombolytic group, ۷۶.۶% and ۲۳.۳% of the cases were males and females, respectively. The mean door-to-balloon time for PCI was ۶۳.۶۰ ± ۲۳.۹۲ and was ۵۳.۷۰ ±۲۱.۵۲ 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 ۰.۲۴ and ۰.۶۶, respectively. Also, the OD of mortality in the primary PCI group was ۲.۱۲. 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)