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Corresponding Author

abdel aziz, Ahmad

Document Type

Original Article

Abstract

Background: Primary percutaneous coronary intervention (PPCI) is the treatment of choice for acute ST-elevation myocardial infarction (STEMI), pharmacoinvasive is an alternative strategy when PPCI is not available within the time Objective: Comparing reperfusion strategies in patients presented by acute anterior STEMI treated by Primary PCI versus streptokinase based pharmaco-invasive strategy regarding the effect on LV remodeling (primary end point), safety and efficacy (secondary end point). Patients and Methods: 100 patients with acute anterior myocardial infarction (STEMI). At Bab Al Sheria hospital (Al-Azhar University), during the period from April 2019 to January 2021, subdivided into 50 patients treated with pharmacoinvasive strategy (group I) and 50 patients treated with primary PCI (group II). Results: Left ventricular remodeling (LVR) occurred in 17 patients (34%) in group I and 15 patients (30%) in group II (P=0.668). GRACE risk score was higher in LVR group than non-remodeling group with cut off value was ≥142.,Total occlusion of left anterior descending coronary artery (LAD); was found in 30 patients (60%) in group II, compared to 8 patients (16%) in group I, (p-value<0.001), while, TIMI III flow post revascularization obtained in 33 (66.0%) in group I and in 29 (58.0%) in group II(P-value= 0.670). Conclusion: The effect of pharmaco-invasive strategy is nearly equal to effect of primary PCI in reduction of LVR post-acute anterior STEMI, with more effect regarding to infarction related artery patency and obtaining TIMI III flow post revascularization, and slightly increased bleeding risk, with same effect regarding development of acute CVA.

Keywords

LVR; 3D Echo-cardiography, GRACE risk score; PPCI, pharmacoinvasive PCI

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