Retrospective observational study comparing two reperfusion strategies in patients with acute STEMI presenting outside office hours

Abstract

Introduction : A pilot cluster-based 24-hour primary percutaneous coronary intervention (PPCI) service in a phased expansion program was launched in October 2018. This study aimed to compare the 30-day mortality and major bleeding event in acute ST-elevation myocardial infarction (STEMI) patients presenting outside of fi ce hours who received historical thrombolytic therapy and PPCI under the newly implemented 24-hour service model. Methods and results : A single center retrospective study was conducted on consecutive STEMI patients presenting outside of fi ce hours, who received urgent thrombolytic therapy or PPCI between 2016-2019. The primary endpoints were 30-day mortality and major bleeding event. The secondary endpoints were thrombolytic failure rate and hospital length of stay. A total of 331 patients were analyzed. 30-day mortality occurred in 11.7% in thrombolytic group and 4.2% in PPCI group ( P ¼ .02). Major bleeding events occurred in 8% in thrombolytic group and 2.1% in PPCI group ( P ¼ .02). Multivariate analysis identi fi ed age ≥ 75 as an independent factor associated with major outcomes. Thrombolytic failure occurred in 31.4% of patients. The median lengths of stay were not different between the two groups (5 vs 4 days, P ¼ .29). Conclusions : Compared with thrombolytic therapy, PPCI in patients with acute STEMI presenting outside of fi ce hours is associated with lower risks of 30-day mortality and major bleeding event. Age ≥ 75 was an independent risk factor associated with mortality and bleeding outcome.