Pharmaco-invasive strategy showed comparable left ventricular function and major adverse events to primary PCI in STEMI, with better strain trends in anterior infarctions.
Does primary percutaneous coronary intervention improve ventricular mechanics compared to a pharmaco-invasive approach in adult patients presenting with STEMI?
A pharmaco-invasive strategy yields comparable cardiac functional outcomes to primary PCI in STEMI patients, supporting its use as an effective alternative when rapid access to interventional facilities is limited.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Myocardial infarction with ST-segment elevation is a leading cause of mortality worldwide. While prompt primary percutaneous coronary intervention is the preferred reperfusion strategy, its availability may be limited in certain regions, prompting the use of pharmaco-invasive approaches. Advanced echocardiographic parameters, including strain analysis, offer a more sensitive evaluation of ventricular function than conventional measures alone, providing a deeper understanding of post-infarct cardiac mechanics. Purpose This study aimed to compare ventricular mechanics, particularly global longitudinal strain, between patients treated with primary percutaneous coronary intervention and those receiving a pharmaco-invasive strategy, in order to evaluate whether either approach leads to superior cardiac functional outcomes. Methods A prospective, observational study of adult patients presenting with myocardial infarction with ST-segment elevation within 12 hours of symptom onset was conducted. One group underwent primary percutaneous coronary intervention (PCI), whereas the other received pharmaco-invasive therapy (fibrinolysis followed by coronary angiography and potential intervention). Standard and advanced echocardiographic parameters—including left ventricle ejection fraction and global longitudinal strain—were assessed in both groups. Results A total of 105 patients were evaluated (50 in the pharmaco-invasive group and 55 in the primary percutaneous coronary intervention group). Demographic and clinical features were broadly similar. Left ventricle ejection fraction and global longitudinal strain showed no statistically significant disadvantage in the pharmaco-invasive group; in fact, for anterior infarctions, strain values showed a trend toward more favorable outcomes in the pharmaco-invasive arm. Major adverse cardiovascular events were also comparable between the two approaches. These findings indicate that both primary PCI and a pharmaco-invasive approach yield broadly comparable outcomes in ST-elevation myocardial infarction, with a modest advantage in anterior-wall strain under the latter strategy. Conclusion Primary percutaneous coronary intervention remains the standard of care where immediately available. However, these results suggest that a pharmaco-invasive strategy can yield similar cardiac functional outcomes, particularly when advanced echocardiographic measures are assessed. Adopting a pharmaco-invasive approach may therefore represent a viable and effective alternative in settings where rapid access to interventional facilities is limited.Echocardiographic Analysis Echocardiographic Parameters
Herrera et al. (Sat,) reported a other. Pharmaco-invasive strategy showed comparable left ventricular function and major adverse events to primary PCI in STEMI, with better strain trends in anterior infarctions.
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