Does timing of percutaneous coronary intervention affect complications and outcomes in STEMI patients following fibrinolysis?

Fibrinolysis (FB) is the pharmacological approach of choice for patients with ST-elevation myocardial infarction (STEMI) whenever primary percutaneous coronary intervention (PCI) is not available within 120 minutes after STEMI diagnosis. After successful FB, PCI is recommended within a 2–24-hour window, but the optimal timing within this period remains unclear regarding potential risks or benefits.

To assess whether PCI performed earlier post-fibrinolysis is associated with increased intra-procedural complications, or differences in in-hospital outcomes.

Retrospective cohort study of 50 STEMI patients who achieved successful clinical and electrocardiographic FB over a 33-month period. Patients were grouped by PCI timing: Group A (GA) received PCI within 6 hours post-FB, and Group B (GB) underwent PCI ≥7 hours post-FB. Baseline characteristics, intra-procedural complications, including thrombogenesis and stent thrombosis, and in-hospital mortality were compared using Chi-square and Mann-Whitney U tests.

Mean age was 63±12 years; 88% were male, and 84% of patients were included in GB. Overall, 72% were overweight/obese, and 8% had a prior PCI. Hospital stay averaged 4.9±5.2 days. Two patients (4%) experienced stent thrombosis. Earlier PCI was significantly associated with increased intraprocedural thrombogenesis (62.5% vs 9.5%; χ²= 12.777; p<0.01) and increased stent thrombosis (25% vs 0%; χ²= 10.938; p=0.02). There was no significant difference in IHM (p=0.29), final TIMI flow (p=0.12), PCI success (p=0.29), fluoroscopy time (p=0.12), procedure duration (p=0.16), or hospital stay duration (p=0.51) between GA and GB.

Earlier PCI following successful FB is associated with an increased risk of intraprocedural thrombogenesis and stent thrombosis. However, PCI timing does not appear to affect in-hospital mortality or procedural success.