• Mohammed K Rashid, Nita Guron, Jordan Bernick, George A Wells, Melissa Blondeau, Aun-Yeong Chong, Alexander Dick, Froeschl Michael P V MPV University of Ottawa Heart Institute, Ottawa, Ontario, Canada., Chris A Glover, Benjamin Hibbert, Marino Labinaz, Jean-François Marquis, Christina Osborne, Derek Y So, and Michel R Le May.
• University of Ottawa Heart Institute, Ottawa, Ontario, Canada; Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
• JACC Cardiovasc Interv. 2016 Oct 10; 9 (19): 2014-2020.

ObjectivesThis study investigated the safety and efficacy of a pharmacoinvasive strategy compared with a primary percutaneous coronary intervention (PCI) strategy for ST-segment elevation myocardial infarction (STEMI) in the context of a real-world system.BackgroundPrimary PCI continues to be the optimal reperfusion therapy; however, in areas where PCI centers are not readily available, a pharmacoinvasive strategy has been proposed.MethodsThe University of Ottawa Heart Institute regional STEMI system provides a primary PCI strategy for patients presenting within a 90-km radius from the PCI center, and a pharmacoinvasive strategy for patients outside this limit. We included all confirmed STEMI patients between April 2009 and May 2011. The primary efficacy outcome was a composite of mortality, reinfarction, or stroke and the primary safety outcome was major bleeding.ResultsWe identified 236 and 980 consecutive patients enrolled in pharmacoinvasive and primary PCI strategies, respectively. The median door-to-needle time was 31 min in the pharmacoinvasive group and the median door-to-balloon time was 95 min in the primary PCI group. In a multivariable model, there was no significant difference in the primary efficacy outcome (odds ratio: 1.54; p = 0.21); however, the propensity for more bleeding with a pharmacoinvasive strategy approached statistical significance (odds ratio: 2.02; p = 0.08).ConclusionsWithin the context of a STEMI system, a pharmacoinvasive strategy was associated with similar rates of the composite of mortality, reinfarction, or stroke as compared with a primary PCI strategy; however, there was a propensity for more bleeding with a pharmacoinvasive strategy.Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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