PCI in Post Thrombolysis Stable STEMI Patients: A Timeline in Question

Irtiza Hasan^1,2*, Tasnuva Rashid³, Md. Harun Ur Rashid Bhuiyan⁴

¹Cardiology, University of Canterbury Christ Church University, Kent, UK.
²Internal Medicine, The University of Edinburgh, Edinburgh, UK.
³Department of Epidemiology, The University of Texas HSC at Houston, School of Public Health, Texas, USA.
⁴Clinical & Interventional Cardiology, Z.H. Sikder Cardiac Care & Research Centre, Dhaka, Bangladesh.

DOI: 10.4236/wjcd.2015.512039                

Abstract

ST elevation myocardial infarction (STEMI) occupies a significant portion of the cardiovascular disease spectrum and poses a continuing challenge on the health care delivery system worldwide. A dilemma exists in the clinical triage system for appropriate strategic modalities of treatment, based on underlying triad of patient-hospital-cardiac pathological factors as well as cut off timelines. Current European Society of Cardiology (ESC) guideline recommends percutaneous coronary intervention (PCI) within 3 to 24 hours in post thrombolysis stable patients. This review critically evaluated the evidences underlying the ESC recommendation. Trials included in this review are SIAM III, GRACIA 1, CAPITAL-AMI, CARESS-IN-AMI, NORDISTEMI, PRAGUE-1, WEST and LEIPZIG. Most of the evidences support the notion for immediate post thrombolysis PCI in stable patients within 1.9 to 2.7 hours, which contradicts the ESC timeline of up to 24 hours. Also, there is a reduced generalizability of the trial results due to differences in the design of the various trials, study population, composite endpoints, variations in drug dose & formulation, co-administration of pharmacotherapies and type of stents used. This warrants further research for standardization & optimization of the treatment protocol with respect to post thrombolysis PCI in stable STEMI patients.

Keywords

ST-Elevation Myocardial Infarction (STEMI), Percutaneous Coronary Intervention (PCI), Thrombolysis, European Society of Cardiology (ESC) Guideline

Conflicts of Interest

The authors declare no conflicts of interest.

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