Fibrinolysis Therapy Combined with Deferred PCI versus Primary Angioplasty for STEMI Patients During the COVID-19 Pandemic: Preliminary Results from a Single Center

Figures & data

Figure 1 Study flow chart.

Figure 2 The process of propensity score-matched analysis.

Table 1 Comparison of the Baseline Demographic and Clinical Characteristics Between the FPCI and PPCI Patients

Variables	Before PSM			After PSM^#
	FPCI (n=17)	PPCI (n=126)	P-value	FPCI (n=9)	PPCI (n=18)	P-value
Age/year	50.8±14.0	64.1±14.2	0.001	60.67 ± 10.97	58.00 ± 11.49	0.569
Male (n,%)	14(82.4)	82(65.1)	0.181	6(66.7)	15(83.3)	1.000
Smoking (n,%)	8(47.1)	44(34.9)	0.421	3 (33.3)	9 (50)	0.681
Hypertension (n,%)	9(52.9)	61(48.4)	0.799	7 (77.8)	8 (44.4)	0.218
Diabetes (n,%)	6(35.3)	55(43.7)	0.607	4 (44.4)	4 (44.4)	1.000
Dyslipidemia (n,%)	10(58.8)	45(35.7)	0.109	3 (33.3)	10 (55.6)	0.496
CKD (n,%)	0(0)	31(24.6)	0.024	0 (0)	2 (11.1)	0.795
PMI (n,%)	3(17.6)	20(15.9)	0.738	1 (11.1)	4 (22.2)	0.861
Premature CAD (n,%)	5(29.4)	14(11.1)	0.053	2 (22.2)	1 (5.6)	0.516
HF (n,%)	2(11.8)	21(16.7)	1.000	2(22.2)	5(27.8)	1.000
AF (n,%)	2(11.8)	20(15.9)	1.000	1(11.1)	2(11.1)	1.000
Prior PCI (n,%)	2(11.8)	14(11.1)	1.000	0(0)	1(5.6)	1.000
Prior CABG (n,%)	0(0)	2(1.6)	1.000	0(0)	0(0)	1.000
ACEI or ARB (n,%)	0(0)	21(16.7)	0.077	0 (0)	2 (11.1)	0.795
β-blockers (n,%)				1 (11.1)	1 (5.6)	1.000
Statins (n,%)	5(29.4)	42(33.3)	1.000	2 (22.2)	5 (27.8)	1.000

Notes: ^#The following variables were used in the propensity score (PSM) model: age, sex, history of diabetes, hypertension, dyslipidemia, family history of premature coronary artery disease, smoking, previous myocardial infarction, CKD, AF, HF, previous PCI, previous CABG, previous use of ACEI or ARB, β-blockers, statins. Bold character indicates that the P value is <0.05.

Abbreviations: FPCI, fibrinolysis therapy combined with deferred PCI; PPCI, primary PCI; PSM, propensity score-matched method; CKD, chronic kidney disease; PMI, previous myocardial infarction; CAD, coronary artery disease; AF, atrial fibrillation; HF, heart failure; PCI, percutaneous coronary intervention; CABG, coronary artery bypass surgery; ACEI, angiotensin-converting enzyme inhibitor; ARB, angiotensin receptor blocker.

Table 2 Comparison of Angiographic and Percutaneous Coronary Intervention Characteristics Between the FPCI and PPCI Patients

Variables	Before PSM			After PSM^#
	FPCI (n=17)	PPCI (n=126)	P-value	FPCI (n=9)	PPCI (n=18)	P-value
Infarct-related artery
Left main (n,%)	0(0)	1(0.8)		0(0)	0(0)
LAD (n,%)	11(64.7)	76(60.3)		5(55.6)	12(66.7)
LCX (n,%)	2(11.8)	13(10.3)		2(22.2)	3(16.7)
RCA (n,%)	4(23.5)	36(28.6)		2(22.2)	3(16.7)
Saphenous vein graft (n,%)	0(0)	0(0)	0.757	0(0)	0(0)	0.668
Location of infraction
Anterior (n,%)	12(70.6)	78(61.9)		6(66.7)	12(66.7)
Inferial (n,%)	5(29.4)	45(35.7)		3(33.3)	5(27.8)
Lateral (n,%)	0(0)	3(2.4)	0.456	0(0)	1(5.6)	0.940
Pre-procedural TIMI grade
0	2(11.8)	110(87.3)		0(0)	15(83.3)
1	0(0)	11(8.7)		0(0)	3(16.7)
2	0(0)	3(2.4)		0(0)	0(0)
3	15(88.2)	2(1.6)	0.000	9(100)	0(0)	0.000
Post-procedural TIMI grade
0	0(0)	0(0)		0(0)	0(0)
1	0(0)	5(4.0)		0(0)	1(5.6)
2	0(0)	21(16.7)		0(0)	4(22.2)
3	17(100)	100(79.4)	0.040	9(100)	13(72.2)	0.235
Risk stratification
TIMI risk score	5(4–6)	5(5–6)	0.172	5.0(4–6)	5.5(5–6)	0.322
GRACE risk score	157.8 ±9.5	169.9 ± 20.3	0.000	155.8± 10.4	166.6± 23.7	0.112
Syntax score	24.0(19.5–26.5)	27.5(22–33)	0.009	22.4±5.7	27.0±7.0	0.104
Stent deployment	17(100)	126(100)	1.000	9(100)	18(100)	1.000
Intra-operation procedure
Thrombus aspiration	0(0)	28(22.2)	0.025	0(0)	3(16.7)	0.529
IABP (n,%)	1(5.9)	34(27.0)	0.072	1(11.1)	4(22.2)	0.636
Temporary pacemaker (n,%)	0(0)	6(4.8)	1.000	0(0)	0(0)	1.000
Vasopressors (n,%)	4(23.5)	69(54.8)	0.020	3(33.3)	10(55.6)	0.420
Cardiogenic shock (n,%)	3(17.6)	17(13.5)	0.708	2(22.2)	2(11.1)	0.582
GPI (n,%)	14(82.4)	122(96.8)	0.037	7(77.8)	18(100)	0.103

Notes: ^#The following variables were used in the propensity score (PSM) model: age, sex, history of diabetes, hypertension, dyslipidemia, family history of premature coronary artery disease, smoking, previous myocardial infarction, CKD, AF, HF, previous PCI, previous CABG, previously use of ACEI or ARB, β-blockers, statins. Bold character indicates that the P value is <0.05.

Abbreviations: FPCI, fibrinolysis therapy combined with deferred PCI; PPCI, primary PCI; PSM, propensity score-matched method; LAD, left anterior descending artery; LCX, left circumflex artery; RCA, right coronary artery; GRACE, Global Registry of Acute Coronary Events; Syntax, Synergy Between Percutaneous Coronary Intervention With Taxus and Cardiac Surgery; IABP, intra-aortic balloon counter-pulsation; GPI, glycoprotein IIb/IIIa inhibitor.

Table 3 Comparison of Door-to-Balloon/Needle Time and In-Hospital Adverse Clinical Outcomes Between the FPCI and PPCI Patients

Variables	Before PSM			After PSM^#
	FPCI (n=17)	PPCI (n=126)	P-value	FPCI (n=9)	PPCI (n=18)	P-value
DTB/DTN (min)	25.8± 4.2	61.1±10.7	0.000	26.9± 4.2	64.9± 23.6	0.000
All-cause of death (n,%)	0 (0)	9 (7.1)	0.599	0 (0)	1(5.6)	1.000
Cardiac death (n,%)	0 (0)	9 (7.1)	0.599	0 (0)	1(5.6)	1.000
MACE (n,%)	0 (0)	12 (9.5)	0.361	0 (0)	1(5.6)	1.000
Non-fatal myocardial infarction (n,%)	0 (0)	5 (4)	1.000	0 (0)	0 (0)	NA
Stroke (n,%)	0 (0)	1 (0.8)	1.000	0 (0)	0 (0)	NA
Any revascularization (n,%)	0 (0)	1 (0.8)	1.000	0 (0)	0 (0)	NA
Stent thrombosis (n,%)	0 (0)	1 (0.8)	1.000	0 (0)	0 (0)	NA
Major bleeding^§ (n,%)	0 (0)	0 (0)	NA	0 (0)	0 (0)	NA
Moderate bleeding^§ (n,%)	1 (5.9)	0 (0)	0.119	1 (11.1)	0 (0)	0.333
Minor bleeding^§ (n,%)	5 (29.4)	6 (4.8)	0.004	2 (22.2)	3 (16.7)	1.000

Notes: ^#The following variables were used in the propensity score model: age, sex, history of diabetes, hypertension, dyslipidemia, family history of coronary artery disease, smoking, previous myocardial infarction, chronic kidney disease (CKD), atrial fibrillation (AF), heart failure (HF), previous PCI, previous coronary artery bypass surgery (CABG), previously usage of ACEI or ARB, β-blockers, statins. ^§Bleeding event is defined by the Global Use of Strategies to Open Occluded Arteries (GUSTO) definition of bleeding. Bold character indicates that the P value is <0.05.

Abbreviations: FPCI, fibrinolysis therapy combined with deferred PCI; PPCI, primary PCI; PSM, propensity score-matched method; MACE, major adverse cardiac event.

Figure 3 Graphic demonstration of the main results.