ST-Segment– Elevation Myocardial Infarction for Pharmacoinvasive Strategy or Primary Percutaneous Coronary Intervention in Gaza (STEPP- PCI)

Background: A primary percutaneous coronary intervention (PCI) Primary PCI continues to be the optimal reperfusion therapy in patients with ST elevation myocardial infarction however, in areas where PCI centers are not readily available, a Pharmacoinvasive strategy has been proposed. This study investigated the safety and efficacy of a Pharmacoinvasive strategy compared with primary (PCI) strategy for ST-segment elevation myocardial infarction (STEMI) in Gaza.

Methods: We randomized 145 patients presenting within 2 hours of symptom onset of acute ST elevation myocardial infarction to primary CPI or for pharmaco-invasive PCI 2-24 hours after streptokinase, except in the event of failed reperfusion, in which case, emergency angiography was recommended. The primary endpoint a composite of death, shock and congestive heart failure at 30 days.

Results: Total 145 patients with mean age 56.5+10.48 years. The primary endpoint in primary PCI (17%) and in pharmaco-invasive PCI (16.1%) p = 0.24. There was no difference in 30-day mortality (4.7 % in primary PCI and 4.9% in Pharmacoinvasive strategy (P=0.94). Secondary endpoints: Emergency angiography was required in 39.5% of the patients in the pharmaco-invasive strategy and the median time for underwent angiography was 6 hours after randomization. TIMI major bleeding occurred among 4 patients (4.9 %) in the Pharmacoinvasive group and in 2 patients (3.1%) of the primary PCI group (P = 0.59). The Pharmacoinvasive group had 1.9 times the odds of having TIMI major bleed compared with the primary PCI group

Conclusions: A strategy of fibrinolysis with streptokinase in emergency room with early angiography resulted in outcomes similar to primary PCI in patients who undergo PCI within 1 hour after medical contact, however, there was a propensity for more bleeding with a Pharmacoinvasive strategy.