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Abstract
Background: In Peshawar, the management of ST-elevation myocardial infarction (STEMI) frequently necessitates the decision between pharmacological reperfusion and primary percutaneous coronary intervention (PCI) based on the resources in the region.
Purpose: The study aims to compare and estimate the 30-day clinical outcomes between Streptokinase and primary PCI in a resource-constrained reality.
Methods: The study was a prospective, multicenter study of 100 consecutive STEMI patients in three tertiary care hospitals in Peshawar (Khyber Teaching Hospital, Lady Reading Hospital and Hayatabad Medical Complex). Patients were randomized to receive either Streptokinase (n=72), or primary PCI (n=28). The main finding was the successful reperfusion (>50 percent ST-segment resolution). The secondary outcomes were 30-day mortality and major bleeding.
Findings: The reperfusion success rate was much higher with primary PCI (92.9%), as opposed to Streptokinase (77.8%). There were also significant differences in 30-day mortality rate with the primary PCI group recording 3.6% against 11.1% in Streptokinase group. Moreover, the significant bleeding events were only noted with the Streptokinase cohort (4.2%), and did not occur in the primary PCI (0.0%).
Conclusion: Primary PCI has better reperfusion success and short-term survival than Streptokinase. But due to the lack of immediate access to PCI in peripheral regions, a health system in resource limited regions should adopt a hub-and-spoke pharmacoinvasive model. It is needed to offer early fibrinolysis at the local centers and then transfer rapidly to a facility with the capability of providing PCI to reduce delays in treatment and enhance survival of patients.