Our study was an observational cross-sectional one, which investigates the safety and efficacy of performing PCI later than 24 h after successful fibrinolytic pharmaco-invasive approach reperfusion. The idea of the study was inspired by the unfortunate bureaucracy which delayed the financial approval on PCI from the insurance organization. Such delay was not consistent with all the guidelines [1, 5]; therefore, 80% of the patients were kept under observation in the hospital until PCI was done. The other patients (20%) were given strict instructions to rush to hospital on the occurrence of any chest pain and were daily followed up by phone. An assessment of such group of postponed PCI, contrary to the guidelines, was therefore worthwhile.
Most of the published trials had a window of 3–24 h after successful fibrinolysis [6,7,8]. In many trials, there was a wide variation of delay between successful thrombolysis to PCI. Median time of PCI in the CAPITAL-AMI trial [9] was 1.3 h, whereas in the GRACIA-1 trial it was 16.7 h [10]. A recent study by Salih Kilica, et al. [11]compared the outcomes of STEMI patients who received successful fibrinolytic treatment and performed PCI within 24—72 h (group 1) or ˃72 h (group 2). Coronary angiography was performed within 2.17 ± 0.38 days in group-1 and 2.9 ± 11.5 days in the Group-2. MACE rate was higher in Group-2 (21.3%) than Group-1(13.8%), but it was not statistically significant (p = 0.661), after 6 months follow-up. Long-term follow-up (median: 57 months) also revealed no statistical significant difference; 37.9% in Group-1 and 38.3% in Group-2 (p = 0.974). Their results showed no difference in MACE for both short- and long-term follow-up groups regarding overall cardiac mortality rate (7.9%), the re-infarction rate (19.7%) and heart failure (17.1%).
Suction device use and IV Eptifibatide administration rate were higher in the earlier PCI group (≤ 24 h.). In this group, suction device was used in 6 patients and IV Eptifibatide was administrated in 7 patients, while only one patient used suction device in the delayed PCI group (> 24 h.) and no patients received IV Eptifibatide (Fig. 1).
Radial access was used more commonly (62.0%) than femoral access (38.0%) of all 129 patients (Fig. 1); 33 (41%) group 1 (≤ 24 h.) and 47 (59%) in group 2 (> 24 h.). The Transradial approach (TRA) could lead to a decrease in incidence of overall bleeding complications [12, 13].
The unplanned delay in PCI timing after successful thrombolytic reperfusion (in second group ˃24 h.) allows for more dual antiplatelet administration. This could diminish the SK-induced platelet aggregation effect [14]. Although no significant difference regarding complication results in both groups; (p = 0.189), earlier PCI had 2 patients one with an ischemic stroke and another one with non-major bleeding. This result illustrates that delay in PCI, after successful SK reperfusion, did not add extra ischemic complications, provided that patients were subject to some restrictions in activity and strict intake of DAPT and were closely observed.