Outcomes of Primary PCI comparing fEmoral versus RAdial arterial access in STEMI – OPERA study

Pillai Siju Balakrishna, Sunitha Vishwanathan, A. George Koshy, Prabha Nini Gupta, K. Sivaprasad
2014 Indian Heart Journal  
defined as reduction by at least 50% of the ST elevation in the lead with the maximum ST elevation. Holter Monitoring for the first 24 hour was done and arrhythmias were documented. Results: Arrhythmias occurred more frequently with successful reperfusion (82% versus 63%) (p¼ 0.04). The occurrence of AIVR with successful reperfusion was highly significant (p¼ 0.015) Though AIVR was found to have low sensitivity (47%) and specificity (77%) as a predictor of successful thrombolysis, early AIVR
more » ... much more common (p¼ 0.019 ) with successful thrombolysis. Successful thrombolysis did not change the incidence of sustained ventricular tachycardia, frequent PVC, AV blocks and A fib. Conclusions: Successful thrombolysis with STK causes more frequent AIVR. Early AIVR is highly predictive for successful thrombolysis. Serious arrhythmias are unaffected by streptokinase. Pre-hospital administration of STK should be safe, thus saving critical time in acute MI. This is especially relevant in large parts of India. Aim and objective: To assess the safety and efficacy of primary PCI by transfer from sattelite centres to PCI capable tertiary centre. Method: A total of 57 cases of STEMI shifted from 2 Non PCI capable satellite centres located 3 and 12 km away from the tertiary centre during a period of 18 months Jan 2013 to July 2014 were included in the study. NSTEMI, patients given lytic tyherapy, presenting with MI beyond 24 hours were excluded. Study cohort included 42 males, 15 females.The age range of pts was 27-81 yrs. All patients were given loading dose of 600 mg clopidogrel/180 mg ticagrelor/60 mg prasugrel, aspirin 325 mg, atorvastatin 80mg, intravenous enoxaparin 0.3 mg, preparation done, stabilzed haemodynamically and transported by fully supported ambulance. Results: The location of MI was anterior in 29 cases, inferior in 20 cases, lateral in 6 cases. The door to balloon time was 40-150 minutes, average of 102 mts. 7 pts presented with cardiogenic shock, 6 pts with pulmonary edema. IABP support was used in 3 pateints, ventilatory support in 3, thromboaspiration in 10 pts. Survival was 56/57 pts. 1 pt with DM, CKD, extensive AWMI, CHB, cardiogenic shock died during procedure, 2 pts with LM disease, 1 pt with failed PCI sent for CABG. PCI was successful in 53/55 pts. Radial access was used in 10 pts. All pts underwent single culprit vessel angioplasty. One pt with double MI underwent sequential RCA, LAD PPCI. 30 day mortality of the entire cohort was 1.75% with a survival rate of 98.2%. Conclusion: It is safe and rewarding to transfer patients PPCI from satellite centres.
doi:10.1016/j.ihj.2014.10.112 fatcat:4vgwqpswwvakzg7cxza4ny4cli