Comparison between Pharmaco-invasive Strategy and Primary Percutaneous Coronary Intervention According to Percutaneous Coronary Intervention Related Delay

Aim: This study aimed to compare between the effect of pharmacoinvasive strategy (PI)& primary percutaneous coronary intervention (P-PCI) according to PCI related delay (door to ballon) on the mortality and morbidity during in-hospital stay and after 30-day follow up. Moreover, left ventricular systolic function was assessed by two-dimensional echocardiography at cardiology department, Tanta University.

Patients and Methods: The study was conducted on 300 patients that were divided into 2 main groups. Group A consisted of patients had primary PCI as reperfusion therapy and further divided into three groups according to PCI related delay (door toballon). Group A1, PCI-related delay is ≤60 minute(92patients). Group A2, PCI-related delay is >60 to ≤ 90 minute. (54patients). Group A3, PCI-related delay is >90minute (78 patients). The second group (group B), include patients who under gopharmaco-invasive strategy, PCI within 24 hour after thrombolysis (76 patients). In the second group, coronary angiography was done immediately in cases of failed thrombolysis and for successful thrombolysis; coronary angiography was performed within 3 – 24 hours.

Results: During hospital stay, more patients in group A3 died than those of group B or group A1, A2 with no statistical significance. In addition, morepatients in group A3 showed heart failure symptoms with statistical significance than those of group B, A1 and A2. Bleeding complications occurred significantly more in group B. During follow up visits more patients in group A3 complained of heart failure symptoms with statistical significance than those of group B, A1, A2 patients.

Conclusion: Primary PCI without door to balloon time delay (≤90 minutes)was encouraged and had the best results on morbidity and mortality. Also, pharmacoinvasive strategy was encouraged as being better than primary PCI when door to balloon time showed marked delay( <90 minutes).