ผลการรักษาผู้ป่วยโรคกล้ามเนื้อหัวใจขาดเลือดเฉียบพลันชนิดเอสทียกระหว่างกลยุทธ์การให้ยาละลายลิ่มเลือดร่วมการสวนหัวใจเร็วและการสวนหัวใจฉุกเฉินปฐมภูมิ: ระบบทะเบียนผู้ป่วยแบบไปข้างหน้าในพื้นที่ภาคเหนือตอนล่างของประเทศไทย

Bhuritat Maungboon

Authors

Bhuritat Maungboon Sawanpracharak Hospital

Keywords:

ST-segment elevation myocardial infarction, coronary reperfusion, pharmacoinvasive, primary percutaneous coronary intervention, streptokinase

Abstract

Objective: The objective of this study is to examine the successful opening of the coronary artery and to compare the effectiveness of treating patients with ST-segment elevation myocardial infarction (STEMI) using pharmacoinvasive strategies (PI) and primary percutaneous coronary intervention (pPCI).

Methods: This study employed a prospective cohort observational design in which patients with STEMI symptoms within a 12-hour window were included. The opening of the blood vessels was achieved through the use of a pharmacoinvasive strategy involving streptokinase (SK) or primary PCI, depending on the local context and adherence to standard time criteria. A total of 384 patients were admitted to Sawan Pracharak Hospital between June 1, 25 and December 31, 2021. The study compared in-hospital and 1-year primary efficacy composite endpoints, including mortality, reinfarction, and cardiogenic shock, as well as primary safety composite endpoints, such as bleeding, arrhythmia, stroke, ejection fraction, mechanical complications, and duration of hospital stay by propensity score matching.

Results: Clinical results during hospital treatment and at 1 year showed that the primary efficacy composite endpoints were death, reinfarction, stroke, heart failure, mechanical complication, and cardiogenic shock in the pPCI group in 18 cases (9.0%) and 20 cases (100% 8.1% each) in the PI group were not significantly different (in-hospital p-value = 0.19 and at 1 year p-value = 0.90) and primary safety endpoints (TIMI major bleeding) were not different between the 2 groups ( p-value = 0.79)

Conclusion: This is the first large-scale Thai prospective registry study comparing strategies. Pharmacoinvasive (PI) and primary PCI (pPCI) in acute STEMI patients in a large rural population in the lower northern region of Thailand were not significantly different in both efficacy and safety. and provide evidence that Pharmacoinvasive reperfusion can be an effective alternative to pPCI in STEMI patients, especially in resource-limited settings.

Keywords: ST-segment elevation myocardial infarction, coronary reperfusion, pharmacoinvasive, primary percutaneous coronary intervention, streptokinase

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