Long Term Outcomes of Pharmacoinvasive Strategy vs. Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction: A Study From Mexico City.

While primary percutaneous coronary intervention (pPCI) is the treatment of choice in ST elevation myocardial infarction (STEMI), challenges may arise in accessing this intervention for certain geodemographic groups. Pharmacoinvasive strategy (PIs) has demonstrated comparable outcomes when delays in pPCI are anticipated, but real-world data on long-term outcomes are limited. The aim of the present study was to compare long-term outcomes among real world patients with STEMI undergoing either PIs or pPCI. This was a prospective registry including patients with STEMI who received reperfusion during the first 12 hours from symptom onset. The primary objective was cardiovascular mortality at 12 months according the reperfusion strategy (pPCI vs PIs); major cardiovascular events (cardiogenic shock, recurrent MI, congestive heart failure) and BARC type 3-5 bleeding events were also evaluated. A total of 799 patients with STEMI were included, 49.1% underwent pPCI and 50.9% received PIs. Patients in the PIs group presented with more heart failure on admission (Killip Kimbal >I 48.1 vs 39.7, p=0.02) and had a lower proportion of pre-existing heart failure (0.2 vs 1.8%, p=0.02) and atrial fibrillation (0.25 vs 1.2%, p=0.02). No statistically significant difference was observed in cardiovascular mortality at the 12-month follow-up (HR for PIs: 0.74, 95% CI: 0.42-1.30; log-rank p=0.30) according to the reperfusion strategy employed. The composite of major cardiovascular events (HR for PIs 0.98, 95% CI: 0.75-1.29, p=0.92) as well as BARC 3-5 bleeding rates were also comparable. A low socioeconomic status, Killip-Kimball >2, age > 60 years and admission creatinine >2.0mg/dL were predictors of the composite endpoint after multivariate analysis. In conclusion, this prospective real-world registry provides additional support that long term major cardiovascular outcomes and bleeding are not different between patients undergoing PIs versus primary PCI.