ArticleJournal of the American Heart Association2025
Comparative Benefits of Primary Percutaneous Coronary Intervention Versus Onsite Fibrinolytic for Patients With ST-Segment-Elevation Myocardial Infarction: A Quasi-Experimental Study.
Article in Journal of the American Heart Association, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Who cites it
3 citing papers in PubMed.
- In Hospital Assessment and Management of High Bleeding Risk in Patients with ST-Elevation Myocardial Infarction (STEMI).Journal of cardiovascular development and disease · 2026Review
- Association of reperfusion delay with inflammatory markers and coronary flow impairment assessed by corrected TIMI frame count in STEMI patients undergoing primary PCI: a cohort study.American journal of cardiovascular disease · 2026Article
- Six-month clinical outcomes after ST-elevation myocardial infarction in eastern Indonesia: a prospective cohort study.Scientific reports · 2025Observational
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Authors and funding
12 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundPrimary percutaneous coronary intervention (PCI) is the preferred reperfusion strategy compared with onsite fibrinolytic therapy (O-FT) for ST-segment-elevation myocardial infarction when delivered promptly. However, the contemporaneous data to inform the comparative benefits of primary PCI versus O-FT, especially in developing countries, have been largely understudied.
methodsWe used data from the National Chest Pain Center Program (NCPCP), the largest nationwide registry in China, including patients with ST-segment-elevation myocardial infarction treated with primary PCI or O-FT from January 2016 to December 2022. Patients were matched using propensity scores, and the PCI-related delay was defined as the difference between the observed door-to-wiring time and the door-to-needle time. Mortality outcomes were assessed at different delay intervals (<60 minutes, 60-90 minutes, >90 minutes). Subgroup analyses were conducted based on age, infarction location, and Killip classification.
resultsIn 19 334 matched patients, primary PCI demonstrated a significant mortality benefit over O-FT when PCI-related delays were <60 minutes (2.34% versus 6.01%). However, this advantage diminished when delays exceeded 90 minutes. The critical threshold at which PCI lost its mortality benefit was identified as 119.51 minutes (door-to-wiring time - door-to-needle time). Subgroup analyses showed that older patients, patients with anterior infarction, and those with a higher Killip class appeared to have lower equipoise thresholds.
conclusionsPrimary PCI offers a mortality benefit compared with O-FT in patients with timely treated ST-segment-elevation myocardial infarction, but treatment delays can mitigate this benefit. In settings with prolonged treatment delays, immediate fibrinolysis may be a more effective strategy. Treatment decisions should incorporate both patient characteristics and health care system constraints to optimize ST-segment-elevation myocardial infarction outcomes.
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