TITLE: OUTCOME OF PATIENT WHO HAD PPCI VERSUS PHARMACOINVASIVE STRATEGY WITH DIFFERENT STAGES OF HEART FAILURE
Main Article Content
Keywords
T-segment elevation myocardial infarction, primary percutaneous coronary intervention, pharmacoinvasive strategy
Abstract
Background: ST-segment elevation myocardial infarction (STEMI) remains a leading cause of cardiovascular morbidity and mortality. Rapid reperfusion is essential to limit myocardial damage, and both primary percutaneous coronary intervention (PPCI) and the pharmacoinvasive strategy (PIS) are widely used reperfusion approaches. This study compared clinical outcomes of PPCI and PIS across different Killip classes.
Objective: To evaluate and compare in-hospital and short-term outcomes of PPCI and PIS in patients with STEMI.
Methods: This prospective observational comparative study was conducted at a tertiary cardiac center. Adult patients presenting within 12 hours of symptom onset and diagnosed with STEMI were included. Patients were managed with either PPCI or fibrinolysis followed by routine early PCI (PIS). Outcomes assessed included mortality, reinfarction, progression of heart failure, cardiogenic shock, major bleeding, and left ventricular ejection fraction (LVEF). Statistical analysis was performed using SPSS version 28, with significance set at p < 0.05.
Results: PPCI demonstrated superior outcomes, particularly in patients with Killip Class II–IV, with significantly lower in-hospital and 30-day mortality, reduced progression to cardiogenic shock, and improved LVEF compared with PIS. In Killip Class I patients, mortality rates were comparable; however, reinfarction and major bleeding were higher in the PIS group. Overall, PPCI provided more consistent myocardial salvage and better clinical stability, whereas PIS remained a viable alternative in settings where immediate PCI was not feasible.
Conclusion: Primary PCI remains the preferred reperfusion strategy for STEMI due to superior survival and functional outcomes. Although pharmacoinvasive therapy is an effective alternative in resource-limited settings, it carries higher risks of bleeding and reinfarction. Future research should focus on optimizing patient selection and refining treatment protocols to enhance outcomes in both strategies.
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Samra Rehmat
Assistant Professor Cardiology, Lady Reading Hospital Peshawar
Said Zaman
Assistant Professor, Cardiology, Lady Reading Hospital Peshawar
Muhammad Zubair Faiz
Assistant Professor, Rawalpindi institute of Cardiology
Jawad Ahmad
Fellow Interventional Cardiology, Lady Reading Hospital Peshawar
