Facilitated percutaneous coronary intervention therapy versus primary percutaneous coronary intervention therapy in acute myocardial infarction

Objective To evalute the efficacy and safety of primary percutaneous coronary intervention (PCI) therapy and facilitated PCI therapy (thrombolysis plus PCI) for acute myocardial infarction (AMI). Methods Sixty four patients with ST elevation myocardial infarction (STEMI) were divided randomly into two groups including the facilitated PCI group and the primary PCI group. The patency rate of infarct-related artery (IRA) before intervention, the incidence of bleeding complications and acute ischemic events during hospitalization as well as the left ventricular ejection fraction (LVEF) measured by echocardiography before discharge were compared. The thrombolysis in myocardial infarction (TIMI) flow grade (TFG), TIMI myocardial perfusion grade (TMPG) and angiographic perfusion score (APS) in all patients were measured before and after PCI and the extent of ST segment elevation resolution was analyzed 90 minutes after reperfusion therapy. The relationship between APS and percentage of complete ST resolution was analysed by linear regression. Results The IRA patency rate and TMPG in the faciliated PCI group were significantly higher than that in the primary PCI group before PCI (P0.05). The faciliated PCI group had higher percentage of complete ST resolution, TFG 3, TMPG 3 and APS (10-12) compared to the primary PCI group after PCI. The LVEF in the faciliated PCI group was higher than that in the primary PCI group before discharge (P0.05). No death, major bleeding complication and ischemic event occurred during hospitalization in both groups. Linear regression analysis showed that APS was directly correlated with the percentage of complete ST resolution (r=0.961, P0.001). Conclusion Faciliated PCI therapy for AMI was effective with improved safety, increased epicardial patency, myocardial tissue level perfusion and better cardiac function. The angiographic perfusion score is an simple, broadly applicable angiographic variable that integrates both epicardial and tissue level perfusion, and closely correlates with ST segment resolution.