ST-elevation myocardial infarction (STEMI) occurs when a coronary artery is completely blocked. A known complication in approximately 6-10% of STEMI patients is cardiogenic shock, a condition that develops when the heart is unable to pump enough blood to the brain and other key organs in the body. The standard best practice approach for patients with STEMI and cardiogenic shock is primary percutaneous coronary intervention (pPCI), a minimally-invasive procedure to open a blocked artery.
In a recent study published in Circulation: Cardiovascular Interventions, researchers examined the efficacy and safety of a pharmacoinvasive strategy in STEMI patients with cardiogenic shock who were unable to receive timely pPCI due to geographical access and longer than average interfacility transport times to PCI-capable hospitals. They compared electrocardiographic reperfusion, clinical outcomes, and bleeding in this patient population in order to evaluate a pharmacoinvasive strategy versus transfer for pPCI.
The study was a retrospective analysis of 426 adult STEMI patients with cardiogenic shock who presented to non-PCI-capable hospitals between 2006 and 2021. Patient data came from the Vital Heart Response Program, which collects information on STEMI patients in a large geographic region encompassing northern and central Alberta, Canada. 53.8% of patients received an initial pharmacoinvasive strategy, and 46.2% were transferred to another hospital for pPCI. The primary clinical outcome for the study was in-hospital mortality, renal failure requiring dialysis, cardiac arrest, or mechanical circulatory support, and the primary safety outcome was major bleeding (intracranial hemorrhage or bleeding requiring transfusion).
The researchers found that a pharmacoinvasive approach was associated with improved electrocardiographic reperfusion, as well as a reduced rate of death, dialysis, or mechanical circulatory support. Additionally, no increase in major bleeding was observed. The authors suggest that a pharmacoinvasive approach may be a safe and effective treatment option for patients with STEMI complicated by cardiogenic shock who present to non-pPCI capable hospitals with prolonged interhospital transport times.
This publication was co-authored by the CVC’s Sean van Diepen, MD, MSC; Yinggan (Gray) Zheng, MA, MEd; Kevin Bainey MD, MSC; and Robert Welsh, MD; along with Janek Senaratne, MD, MSc (University of Alberta); Benjamin Tyrrell, MD and Debraj Das, MD,MSc (CK Hui Heart Centre); Holger Thiele, MD (University of Leipzig); and Timothy Henry, MD (Carl and Edyth Lindner Research Center, Christ Hospital).
