Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST‐Segment–Elevation Myocardial Infarction: A Quasi‐Experimental Study
Background Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy compared with onsite fibrinolytic therapy (O‐FT) for ST‐segment–elevation myocardial infarction when delivered promptly. However, the contemporaneous data to inform the comparative benefits of primary P...
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2025-07-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.125.041995 |
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| author | Shuduo Zhou Siwei Xie Binquan You Dingcheng Xiang Weiyi Fang Michael G. Trisolini Kenneth A. Labresh Sidney C. Smith Zhi‐Jie Zheng Yinzi Jin Feng Liu Yong Huo |
| author_facet | Shuduo Zhou Siwei Xie Binquan You Dingcheng Xiang Weiyi Fang Michael G. Trisolini Kenneth A. Labresh Sidney C. Smith Zhi‐Jie Zheng Yinzi Jin Feng Liu Yong Huo |
| author_sort | Shuduo Zhou |
| collection | DOAJ |
| description | Background Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy compared with onsite fibrinolytic therapy (O‐FT) for ST‐segment–elevation myocardial infarction when delivered promptly. However, the contemporaneous data to inform the comparative benefits of primary PCI versus O‐FT, especially in developing countries, have been largely understudied. Methods We used data from the National Chest Pain Center Program (NCPCP), the largest nationwide registry in China, including patients with ST‐segment–elevation myocardial infarction treated with primary PCI or O‐FT from January 2016 to December 2022. Patients were matched using propensity scores, and the PCI‐related delay was defined as the difference between the observed door‐to‐wiring time and the door‐to‐needle time. Mortality outcomes were assessed at different delay intervals (<60 minutes, 60–90 minutes, >90 minutes). Subgroup analyses were conducted based on age, infarction location, and Killip classification. Results In 19 334 matched patients, primary PCI demonstrated a significant mortality benefit over O‐FT when PCI‐related delays were <60 minutes (2.34% versus 6.01%). However, this advantage diminished when delays exceeded 90 minutes. The critical threshold at which PCI lost its mortality benefit was identified as 119.51 minutes (door‐to‐wiring time – door‐to‐needle time). Subgroup analyses showed that older patients, patients with anterior infarction, and those with a higher Killip class appeared to have lower equipoise thresholds. Conclusions Primary PCI offers a mortality benefit compared with O‐FT in patients with timely treated ST‐segment–elevation myocardial infarction, but treatment delays can mitigate this benefit. In settings with prolonged treatment delays, immediate fibrinolysis may be a more effective strategy. Treatment decisions should incorporate both patient characteristics and health care system constraints to optimize ST‐segment–elevation myocardial infarction outcomes. |
| format | Article |
| id | doaj-art-86cf3fa1b08e436d90a54d26e726ca1d |
| institution | Matheson Library |
| issn | 2047-9980 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-86cf3fa1b08e436d90a54d26e726ca1d2025-07-30T11:56:38ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802025-07-01141310.1161/JAHA.125.041995Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST‐Segment–Elevation Myocardial Infarction: A Quasi‐Experimental StudyShuduo Zhou0Siwei Xie1Binquan You2Dingcheng Xiang3Weiyi Fang4Michael G. Trisolini5Kenneth A. Labresh6Sidney C. Smith7Zhi‐Jie Zheng8Yinzi Jin9Feng Liu10Yong Huo11Department of Biostatistics Peking University First Hospital Beijing ChinaDepartment of Biostatistics Peking University First Hospital Beijing ChinaDepartment of Cardiology, Department of Cardiology Kowloon Hospital, Shanghai Jiaotong University, School of Medicine Suzhou ChinaDepartment of Cardiology General Hospital of Southern Theater Command of PLA Guangzhou ChinaDepartment of Cardiology Huadong Hospital Affiliated to Fudan University Shanghai ChinaDepartment of Public Health and Health Sciences Northeastern University Boston MA USARTI International Research Triangle Park NC USADivision of Cardiology, School of Medicine University of North Carolina at Chapel Hill Chapel Hill NC USADepartment of Global Health Peking University School of Public Health Beijing ChinaDepartment of Global Health Peking University School of Public Health Beijing ChinaDepartment of Cardiology, Department of Cardiology Kowloon Hospital, Shanghai Jiaotong University, School of Medicine Suzhou ChinaDepartment of Cardiology Peking University First Hospital Beijing ChinaBackground Primary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy compared with onsite fibrinolytic therapy (O‐FT) for ST‐segment–elevation myocardial infarction when delivered promptly. However, the contemporaneous data to inform the comparative benefits of primary PCI versus O‐FT, especially in developing countries, have been largely understudied. Methods We used data from the National Chest Pain Center Program (NCPCP), the largest nationwide registry in China, including patients with ST‐segment–elevation myocardial infarction treated with primary PCI or O‐FT from January 2016 to December 2022. Patients were matched using propensity scores, and the PCI‐related delay was defined as the difference between the observed door‐to‐wiring time and the door‐to‐needle time. Mortality outcomes were assessed at different delay intervals (<60 minutes, 60–90 minutes, >90 minutes). Subgroup analyses were conducted based on age, infarction location, and Killip classification. Results In 19 334 matched patients, primary PCI demonstrated a significant mortality benefit over O‐FT when PCI‐related delays were <60 minutes (2.34% versus 6.01%). However, this advantage diminished when delays exceeded 90 minutes. The critical threshold at which PCI lost its mortality benefit was identified as 119.51 minutes (door‐to‐wiring time – door‐to‐needle time). Subgroup analyses showed that older patients, patients with anterior infarction, and those with a higher Killip class appeared to have lower equipoise thresholds. Conclusions Primary PCI offers a mortality benefit compared with O‐FT in patients with timely treated ST‐segment–elevation myocardial infarction, but treatment delays can mitigate this benefit. In settings with prolonged treatment delays, immediate fibrinolysis may be a more effective strategy. Treatment decisions should incorporate both patient characteristics and health care system constraints to optimize ST‐segment–elevation myocardial infarction outcomes.https://www.ahajournals.org/doi/10.1161/JAHA.125.041995comparative researchfibrinolysismyocardial infarctionpercutaneous coronary interventiontransfer |
| spellingShingle | Shuduo Zhou Siwei Xie Binquan You Dingcheng Xiang Weiyi Fang Michael G. Trisolini Kenneth A. Labresh Sidney C. Smith Zhi‐Jie Zheng Yinzi Jin Feng Liu Yong Huo Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST‐Segment–Elevation Myocardial Infarction: A Quasi‐Experimental Study Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease comparative research fibrinolysis myocardial infarction percutaneous coronary intervention transfer |
| title | Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST‐Segment–Elevation Myocardial Infarction: A Quasi‐Experimental Study |
| title_full | Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST‐Segment–Elevation Myocardial Infarction: A Quasi‐Experimental Study |
| title_fullStr | Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST‐Segment–Elevation Myocardial Infarction: A Quasi‐Experimental Study |
| title_full_unstemmed | Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST‐Segment–Elevation Myocardial Infarction: A Quasi‐Experimental Study |
| title_short | Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST‐Segment–Elevation Myocardial Infarction: A Quasi‐Experimental Study |
| title_sort | comparative benefits of primary percutaneous coronary intervention versus onsite fibrinolytic for patients with st segment elevation myocardial infarction a quasi experimental study |
| topic | comparative research fibrinolysis myocardial infarction percutaneous coronary intervention transfer |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.125.041995 |
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