Arq. Bras. Cardiol. 2022; 119(5): 703-704
Pharmacoinvasive Strategy in ST-Elevation Myocardial Infarction in Brazil: Female Sex as a Prognostic Factor
This Short Editorial is referred by the Research article "Pharmaco-invasive Strategy in Myocardial Infarction: Descriptive Analysis, Presentation of Ischemic Symptoms and Mortality Predictors".
Primary percutaneous coronary intervention (PCI) is the recommended therapy in patients with acute ST-elevation myocardial infarction (STEMI). In locations without immediate PCI capability or in the presence of an anticipated delay from hospital presentation to primary PCI >120 minutes, fibrinolysis is indicated. In these cases, invasive angiography and PCI 3 to 24 hours after fibrinolysis may improve the prognosis and are recommended as class 2a by the recent ACC/AHA/SCAI Guideline for Coronary Artery Revascularization. The rationale for early routine PCI after fibrinolysis, the so-called pharmacoinvasive strategy, is that lytic therapy provides adequate (TIMI 3 grade) blood flow in only 50-60% of the cases. PCI can then relieve residual stenosis and restore normal flow, which is related to the benefit of reperfusion in reducing mortality. Importantly, early invasive angiography should follow fibrinolysis independently of the resolution of the ST-segment elevation since electrocardiogram changes have poor accuracy in identifying adequate reperfusion.
The recommendation for the pharmacoinvasive strategy is supported by several randomized controlled trials (RCTs) and meta-analyses demonstrating clinical benefits over previous standard therapy. Moreover, the STREAM trial provided evidence that pre-hospital fibrinolysis followed by PCI after 6 to 24 hours is as efficacious as primary PCI in STEMI patients who cannot undergo primary PCI within 1 hour after the diagnosis.,
[…]
792
