{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,20]],"date-time":"2026-08-20T15:13:13Z","timestamp":1787238793561,"version":"build-2736575974"},"reference-count":24,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2019,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recent clinical trial data support a pharmacoinvasive strategy as an alternative to primary percutaneous coronary intervention (pPCI) in ST-segment elevation myocardial infarction. We evaluated whether this is true in a real-world prehospital ST-segment elevation myocardial infarction network using ECG assessment of reperfusion coupled with clinical outcomes within 1 year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Of the 5583 ST-segment elevation myocardial infarction patients in the Alberta Vital Heart Response Program (Cohort 1 [2006\u20132011]: n=3593; Cohort 2 [2013\u20132016]: n=1990), we studied 3287 patients who received a pharmacoinvasive strategy with tenecteplase (April 2013: half-dose tenecteplase was employed in prehospital patients \u226575 years) or pPCI. ECGs were analyzed within a core laboratory; sum ST-segment deviation resolution \u226550% was defined as successful reperfusion. The primary composite was all-cause death, congestive heart failure, cardiogenic shock, and recurrent myocardial infarction within 1 year.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      The pharmacoinvasive approach was administered in 1805 patients (54.9%), (493 [27.3%] underwent rescue\/urgent percutaneous coronary intervention and 1312 [72.7%] had scheduled angiography); pPCI was performed in 1482 patients (45.1%). There was greater ST-segment resolution post-catheterization\/percutaneous coronary intervention with a pharmacoinvasive strategy versus pPCI (75.8% versus 64.3%, IP-weighted odds ratio, 1.59; 95% CI, 1.33\u20131.90;\n                      <jats:italic>P<\/jats:italic>\n                      &lt;0.001). The primary composite was significantly lower with a pharmacoinvasive approach (16.3% versus 23.1%, IP-weighted hazard ratio, 0.84; 95% CI, 0.72\u20130.99;\n                      <jats:italic>P<\/jats:italic>\n                      =0.033). Major bleeding and intracranial hemorrhage were similar between a pharmacoinvasive strategy and pPCI (7.6% versus 7.5%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.867; 0.6% versus 0.6%;\n                      <jats:italic>P<\/jats:italic>\n                      =0.841, respectively). In the 82 patients \u226575 years with a prehospital pharmacoinvasive strategy, similar ST-segment resolution and rescue rates were observed with full-dose versus half-dose tenecteplase (75.8% versus 88.9%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.259; 31.0% versus 29.2%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.867) with no difference in the primary composite (31.0% versus 25.0%,\n                      <jats:italic>P<\/jats:italic>\n                      =0.585).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In this large Canadian ST-segment elevation myocardial infarction registry, a pharmacoinvasive strategy was associated with improved ST-segment resolution and enhanced outcomes within 1 year compared with pPCI. Our findings support the application of a selective pharmacoinvasive reperfusion strategy when delay to pPCI exists.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circinterventions.119.008059","type":"journal-article","created":{"date-parts":[[2019,10,14]],"date-time":"2019-10-14T05:00:28Z","timestamp":1571029228000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction in Clinical Practice"],"prefix":"10.1161","volume":"12","author":[{"given":"Kevin R.","family":"Bainey","sequence":"first","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada."},{"name":"Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada."},{"name":"Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul W.","family":"Armstrong","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada."},{"name":"Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yinggan","family":"Zheng","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Neil","family":"Brass","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada."},{"name":"CK Hui Heart Centre, Edmonton, Alberta, Canada (N.B., B.D.T., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin D.","family":"Tyrrell","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada."},{"name":"CK Hui Heart Centre, Edmonton, Alberta, Canada (N.B., B.D.T., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Leung","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada."},{"name":"CK Hui Heart Centre, Edmonton, Alberta, Canada (N.B., B.D.T., R.L.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cynthia M.","family":"Westerhout","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert C.","family":"Welsh","sequence":"additional","affiliation":[{"name":"Canadian VIGOUR Centre (K.R.B., P.W.A., Y.Z., C.M.W., R.C.W.), University of Alberta, Edmonton, Canada."},{"name":"Division of Cardiology, Department of Medicine (K.R.B., P.W.A., N.B., B.D.T., R.L., R.C.W.), University of Alberta, Edmonton, Canada."},{"name":"Mazankowski Alberta Heart Institute, Edmonton, Canada (K.R.B., R.C.W.)."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_4_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.cjca.2018.11.031"},{"key":"e_1_3_4_3_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehx393"},{"key":"e_1_3_4_4_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIR.0b013e3182742cf6"},{"key":"e_1_3_4_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2014.6573"},{"key":"e_1_3_4_6_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.1139"},{"key":"e_1_3_4_7_2","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2010.712"},{"key":"e_1_3_4_8_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehy004"},{"key":"e_1_3_4_9_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinternmed.2011.57"},{"key":"e_1_3_4_10_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.114.009570"},{"key":"e_1_3_4_11_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMc1305999"},{"key":"e_1_3_4_12_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehr403"},{"key":"e_1_3_4_13_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCINTERVENTIONS.117.005399"},{"key":"e_1_3_4_14_2","doi-asserted-by":"publisher","DOI":"10.1093\/eurheartj\/ehp494"},{"key":"e_1_3_4_15_2","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.108.767772"},{"key":"e_1_3_4_16_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjcard.2014.06.011"},{"key":"e_1_3_4_17_2","unstructured":"Robins JM. 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