20-Year Experience of Endovascular Reperfusion Therapy of AMI with and without Pre-hospital Thrombolysis

Dmitrii Kurtasov, David Iosseliani, Ilia Kovalchuk, Dzhamil Asadov, Irina Chernisheva, Elena Ozolinia

MCCIC, Moscow, Russia

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–A

Abstract

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Purpose: to compareearly in-hospital results of endovascular reperfusion therapy with (1 group, n=1 612) and without (2 group, n= 5 585) pre-hospital thrombolysis in AMI.

Material and methods: 7197 AMI patients (73,1%) had PCI of the IRA. In a megalopolis, the patients with AMI are very unlikely to arrive to the Cath.Lab for myocardial reperfusion within the “gold standard” interval for PCI (> 90мин.), for this reason pre-hospital thrombolysis had been so common. The average pain-to-needle time was similar in both group and ranged 262±21 min. The average pain-to-thrombolytic administration time in group 1 was 114±46 min. and the interval between the start of thrombolysis and the procedure of PCI was ~ 130 min.

Results: Diagnostic CAG showed restoration of antegrade blood flow in the IRA (TIMI 2-3) more common in group 1 – 68,2%, than in group 2 – 23,1% (p=0,0001). Optimal results of endovascular treatment were achieved in most cases (~87,5%) in both groups. CPK and CPK-MB were1353±929 U/l and 175±121 U/l in group 1 and 1454±1008 U/l and 177±128 U/l in group 2 (p=0,0654). LV EF after PCI was 52,3±7,3% in group 1 and 48,3±7,7% in group 2 (p=0<046). Clinical course was uneventful in 82,9% in group 1 and in 83,2% in group 2 (p >0,05). There was no significant differences in MACE. In-hospital mortality was 3,9% and 5,1% in group 1 and group 2 (p=0,026).

Conclusions. In cases, when endovascular myocardial perfusion is unlikely to be performed within the frames of the “gold standard” (90 min.), pre-hospital thrombolysis allows to obtain somewhat better results in comparison with the cases without pre-hospital TLT.