STEPP-AMI Two-Year Follow-up: Pharmacoinvasive Strategy vs. Primary PCI in Indian STEMI Patients

Introduction

Implementing a pharmacoinvasive strategy (initial bolus lysis followed by appropriate percutaneous coronary intervention [PCI]) might alleviate various barriers that delay the reperfusion of ST-segment elevation myocardial infarction (STEMI), particularly in a developing country like India.

Aim

To determine the safety, efficacy and feasibility of pharmacoinvasive strategy vs. primary PCI (PPCI) in STEMI patients at 2 years

Patient Profile

• Patients with STEMI presenting within 12 h of onset of symptoms and requiring a reperfusion strategy (n=200; age, 18-75 years)

Method

Study Design

• Prospective, observational, multicenter pilot study

Treatment Strategy

Primary Endpoint

• A composite of death, cardiogenic shock, reinfarction, repeat revascularization, and congestive heart failure at 30 days and followed up till 2 years

Safety endpoints

• Bleeding endpoints assessed using the TIMI classification at 30 days and till 2 years

Results

• Incidence of primary endpoint was similar in pharmacoinvasive and primary PCI groups at 2 years (17.8% vs. 13.6%, relative risk (RR)=1.31; p=0.47) (Figure 1)
• Primary endpoint remained similar in both the groups even after adjustment for age, sex & Killip's class  (at end of 2 years: 17.8% vs. 13.6%, RR=1.15; p=0.69
• Bleeding risk did not differ significantly in the study groups (2.2% vs. 0.6%; p=0.4)

Conclusion

• Prompt pharmacoinvasive strategy is similar to PPCI in terms of efficacy and safety even at the end of 2 years
• The findings support the approach of adopting a pharmacoinvasive strategy in the settings where patient and system-related delays are inherent

Indian Heart J 2016; 168: 169-73