Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspective
BackgroundThe pharmacoinvasive (PhI) strategy is the standard-of-care for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (pPCI) is unfeasible. Optimal timing for post-fibrinolytic PCI (lysis-PCI) remains elusive. Therefore, this study aimed to ass...
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Frontiers Media S.A.
2025-01-01
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| Series: | Frontiers in Cardiovascular Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1466961/full |
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| author | Andrea Dias Stephanus Alice Pacheco Santos Ana Carolina Machado Rodrigues da Cunha Ana Carolina Augusto Rocha Amanda de Amorim Meireles Mariana Guimarães Souza de Oliveira Pietra Arissa Coelho Matsunaga Alexandre Anderson de Sousa Munhoz Soares Alexandre Anderson de Sousa Munhoz Soares Ana Claudia Cavalcante Nogueira Ana Claudia Cavalcante Nogueira Ana Claudia Cavalcante Nogueira Ana Claudia Cavalcante Nogueira Adriana de J. B. de Almeida Guimarães Adriana de J. B. de Almeida Guimarães Gustavo de Almeida Alexim Alessandra M. Campos-Staffico Luiz Sergio Fernandes de Carvalho Luiz Sergio Fernandes de Carvalho Luiz Sergio Fernandes de Carvalho |
| author_facet | Andrea Dias Stephanus Alice Pacheco Santos Ana Carolina Machado Rodrigues da Cunha Ana Carolina Augusto Rocha Amanda de Amorim Meireles Mariana Guimarães Souza de Oliveira Pietra Arissa Coelho Matsunaga Alexandre Anderson de Sousa Munhoz Soares Alexandre Anderson de Sousa Munhoz Soares Ana Claudia Cavalcante Nogueira Ana Claudia Cavalcante Nogueira Ana Claudia Cavalcante Nogueira Ana Claudia Cavalcante Nogueira Adriana de J. B. de Almeida Guimarães Adriana de J. B. de Almeida Guimarães Gustavo de Almeida Alexim Alessandra M. Campos-Staffico Luiz Sergio Fernandes de Carvalho Luiz Sergio Fernandes de Carvalho Luiz Sergio Fernandes de Carvalho |
| author_sort | Andrea Dias Stephanus |
| collection | DOAJ |
| description | BackgroundThe pharmacoinvasive (PhI) strategy is the standard-of-care for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (pPCI) is unfeasible. Optimal timing for post-fibrinolytic PCI (lysis-PCI) remains elusive. Therefore, this study aimed to assess the clinical and economic impacts of early vs. delayed lysis-PCI in patients with STEMI.MethodsThis retrospective cohort study included 1,043 STEMI patients classified by lysis-PCI timing. The primary outcome was in-hospital major adverse cardiovascular events (4p-MACE), with secondary outcomes such as 3p-MACE, in-hospital mortality, and costs. Multivariable logistic regression models were used to assess the association between lysis-PCI timing and outcomes. Cost analyses were conducted from the perspective of Brazilian public healthcare system, with values converted to international dollars (Int$) for broader applicability.ResultsEvery 4-h delay in lysis-PCI was associated with a 44% reduction in in-hospital mortality [OR = 0.560 (95% CI: 0.381–0.775); p = 0.001] and a 13% decrease in 4p-MACE [OR = 0.877 (95% CI: 0.811–0.948); p = 0.001]. Additionally, 4-h delay in lysis-PCI was also associated with a significant reduction in in-hospital costs (Int$916.20 ± 99) and disease-induced years of productivity lost (β = −41.79 ± 151 years; p = 0.001). These significant trends remained consistent even after adjusting for confounders and applying propensity score matching. Older adults (aged ≥80) experienced an increase in 3p-MACE with earlier lysis-PCI.ConclusionDelaying lysis-PCI was found to be associated with reduced in-hospital cardiovascular adverse events and lower costs, particularly among older adults. Further research should develop evidence-based lysis-PCI protocols that optimize both clinical outcomes and cost-effectiveness. |
| format | Article |
| id | doaj-art-117180a865484d9cacfd00d3ce6b2ea5 |
| institution | Kabale University |
| issn | 2297-055X |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Cardiovascular Medicine |
| spelling | doaj-art-117180a865484d9cacfd00d3ce6b2ea52025-01-14T06:10:42ZengFrontiers Media S.A.Frontiers in Cardiovascular Medicine2297-055X2025-01-011110.3389/fcvm.2024.14669611466961Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspectiveAndrea Dias Stephanus0Alice Pacheco Santos1Ana Carolina Machado Rodrigues da Cunha2Ana Carolina Augusto Rocha3Amanda de Amorim Meireles4Mariana Guimarães Souza de Oliveira5Pietra Arissa Coelho Matsunaga6Alexandre Anderson de Sousa Munhoz Soares7Alexandre Anderson de Sousa Munhoz Soares8Ana Claudia Cavalcante Nogueira9Ana Claudia Cavalcante Nogueira10Ana Claudia Cavalcante Nogueira11Ana Claudia Cavalcante Nogueira12Adriana de J. B. de Almeida Guimarães13Adriana de J. B. de Almeida Guimarães14Gustavo de Almeida Alexim15Alessandra M. Campos-Staffico16Luiz Sergio Fernandes de Carvalho17Luiz Sergio Fernandes de Carvalho18Luiz Sergio Fernandes de Carvalho19Laboratory of Data for Quality of Care and Outcomes Research (LaDa:QCOR), Catholic University of Brasilia, Brasília, BrazilLaboratory of Data for Quality of Care and Outcomes Research (LaDa:QCOR), Catholic University of Brasilia, Brasília, BrazilLaboratory of Data for Quality of Care and Outcomes Research (LaDa:QCOR), Catholic University of Brasilia, Brasília, BrazilLaboratory of Data for Quality of Care and Outcomes Research (LaDa:QCOR), Catholic University of Brasilia, Brasília, BrazilLaboratory of Data for Quality of Care and Outcomes Research (LaDa:QCOR), Catholic University of Brasilia, Brasília, BrazilLaboratory of Data for Quality of Care and Outcomes Research (LaDa:QCOR), Catholic University of Brasilia, Brasília, BrazilLaboratory of Data for Quality of Care and Outcomes Research (LaDa:QCOR), Catholic University of Brasilia, Brasília, BrazilAramari Apo Institute, Brasília, BrazilHEOR, Clarity Healthcare Intelligence, Jundiaí, BrazilAramari Apo Institute, Brasília, BrazilHEOR, Clarity Healthcare Intelligence, Jundiaí, BrazilEscola Superior de Ciências da Saúde (ESCS), Brasília, BrazilSecretaria de Estado de Saúde do Distrito Federal (SES-DF), Brasília, BrazilEscola Superior de Ciências da Saúde (ESCS), Brasília, BrazilSecretaria de Estado de Saúde do Distrito Federal (SES-DF), Brasília, BrazilSecretaria de Estado de Saúde do Distrito Federal (SES-DF), Brasília, BrazilDepartment of Pharmacy Sciences | School of Pharmacy and Health Professions, Creighton University, Omaha, NE, United StatesLaboratory of Data for Quality of Care and Outcomes Research (LaDa:QCOR), Catholic University of Brasilia, Brasília, BrazilAramari Apo Institute, Brasília, BrazilHEOR, Clarity Healthcare Intelligence, Jundiaí, BrazilBackgroundThe pharmacoinvasive (PhI) strategy is the standard-of-care for ST-elevation myocardial infarction (STEMI) patients when primary percutaneous coronary intervention (pPCI) is unfeasible. Optimal timing for post-fibrinolytic PCI (lysis-PCI) remains elusive. Therefore, this study aimed to assess the clinical and economic impacts of early vs. delayed lysis-PCI in patients with STEMI.MethodsThis retrospective cohort study included 1,043 STEMI patients classified by lysis-PCI timing. The primary outcome was in-hospital major adverse cardiovascular events (4p-MACE), with secondary outcomes such as 3p-MACE, in-hospital mortality, and costs. Multivariable logistic regression models were used to assess the association between lysis-PCI timing and outcomes. Cost analyses were conducted from the perspective of Brazilian public healthcare system, with values converted to international dollars (Int$) for broader applicability.ResultsEvery 4-h delay in lysis-PCI was associated with a 44% reduction in in-hospital mortality [OR = 0.560 (95% CI: 0.381–0.775); p = 0.001] and a 13% decrease in 4p-MACE [OR = 0.877 (95% CI: 0.811–0.948); p = 0.001]. Additionally, 4-h delay in lysis-PCI was also associated with a significant reduction in in-hospital costs (Int$916.20 ± 99) and disease-induced years of productivity lost (β = −41.79 ± 151 years; p = 0.001). These significant trends remained consistent even after adjusting for confounders and applying propensity score matching. Older adults (aged ≥80) experienced an increase in 3p-MACE with earlier lysis-PCI.ConclusionDelaying lysis-PCI was found to be associated with reduced in-hospital cardiovascular adverse events and lower costs, particularly among older adults. Further research should develop evidence-based lysis-PCI protocols that optimize both clinical outcomes and cost-effectiveness.https://www.frontiersin.org/articles/10.3389/fcvm.2024.1466961/fullST-segment elevation myocardial infarctionfibrinolysispercutaneous coronary interventionpharmacoinvasive strategyreperfusion strategy |
| spellingShingle | Andrea Dias Stephanus Alice Pacheco Santos Ana Carolina Machado Rodrigues da Cunha Ana Carolina Augusto Rocha Amanda de Amorim Meireles Mariana Guimarães Souza de Oliveira Pietra Arissa Coelho Matsunaga Alexandre Anderson de Sousa Munhoz Soares Alexandre Anderson de Sousa Munhoz Soares Ana Claudia Cavalcante Nogueira Ana Claudia Cavalcante Nogueira Ana Claudia Cavalcante Nogueira Ana Claudia Cavalcante Nogueira Adriana de J. B. de Almeida Guimarães Adriana de J. B. de Almeida Guimarães Gustavo de Almeida Alexim Alessandra M. Campos-Staffico Luiz Sergio Fernandes de Carvalho Luiz Sergio Fernandes de Carvalho Luiz Sergio Fernandes de Carvalho Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspective Frontiers in Cardiovascular Medicine ST-segment elevation myocardial infarction fibrinolysis percutaneous coronary intervention pharmacoinvasive strategy reperfusion strategy |
| title | Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspective |
| title_full | Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspective |
| title_fullStr | Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspective |
| title_full_unstemmed | Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspective |
| title_short | Optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with ST-elevation myocardial infarction: a real-world perspective |
| title_sort | optimal timing of pharmacoinvasive strategy and its impact on clinical and economic outcomes in patients with st elevation myocardial infarction a real world perspective |
| topic | ST-segment elevation myocardial infarction fibrinolysis percutaneous coronary intervention pharmacoinvasive strategy reperfusion strategy |
| url | https://www.frontiersin.org/articles/10.3389/fcvm.2024.1466961/full |
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