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This study sought to compare the outcomes of STEMI-CS receiving initial fibrinolysis vs. primary percutaneous coronary intervention (PPCI).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using the National (Nationwide) Inpatient Sample from 2009 to 2017, a comparative effectiveness study of adult (&amp;gt;18 years) STEMI-CS admissions receiving pre-hospital\/in-hospital fibrinolysis were compared with those receiving PPCI. Admissions with alternate indications for fibrinolysis and STEMI-CS managed medically or with surgical revascularization (without fibrinolysis) were excluded. Outcomes of interest included in-hospital mortality, development of non-cardiac organ failure, complications, hospital length of stay, hospitalization costs, use of palliative care, and do-not-resuscitate status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>During 2009\u20132017, 5297 and 110 452 admissions received initial fibrinolysis and PPCI, respectively. Compared with those receiving PPCI, the fibrinolysis group was more often non-White, with lower co-morbidity, and admitted on weekends and to small rural hospitals (all P &amp;lt; 0.001). In the fibrinolysis group, 95.3%, 77.4%, and 15.7% received angiography, PCI, and coronary artery bypass grafting, respectively. The fibrinolysis group had higher rates of haemorrhagic complications (13.5% vs. 9.9%; P &amp;lt; 0.001). The fibrinolysis group had comparable all-cause in-hospital mortality [logistic regression analysis: 28.8% vs. 28.5%; propensity-matched analysis: 30.8% vs. 30.3%; adjusted odds ratio 0.97 (95% confidence interval 0.90\u20131.05); P = 0.50]. The fibrinolysis group had comparable rates of acute organ failure, hospital length of stay, rates of palliative care referrals, do-not-resuscitate status use, and lesser hospitalization costs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The use of initial fibrinolysis had comparable in-hospital mortality than those receiving PPCI in STEMI-CS in the contemporary era in this large national observational study.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ehf2.13281","type":"journal-article","created":{"date-parts":[[2021,3,11]],"date-time":"2021-03-11T07:46:40Z","timestamp":1615448800000},"page":"2025-2035","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Fibrinolysis vs. Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction Cardiogenic Shock"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1631-8238","authenticated-orcid":false,"given":"Saraschandra","family":"Vallabhajosyula","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]},{"name":"Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]},{"name":"Center for Clinical and Translational Science, Mayo Clinic Graduate School of Biomedical Sciences , Rochester, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dhiran","family":"Verghese","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology, Division of Cardiovascular Medicine, Department of Medicine, Emory University School of Medicine , 1364 Clifton Road NE, Atlanta, GA, 30322 ,","place":["USA"]},{"name":"Department of Medicine, Amita Health Saint Joseph Hospital , Chicago, IL ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Malcolm R.","family":"Bell","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis H.","family":"Murphree","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wisit","family":"Cheungpasitporn","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Department of Medicine, University of Mississippi School of Medicine , Jackson, MS ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"P. Elliott","family":"Miller","sequence":"additional","affiliation":[{"name":"Division of Cardiovascular Medicine, Department of Medicine, Yale University School of Medicine , New Haven, CT ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shannon M.","family":"Dunlay","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]},{"name":"Department of Health Sciences Research, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Abhiram","family":"Prasad","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gurpreet S.","family":"Sandhu","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Mayo Clinic , Rochester, MN 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