{"id":"566f3ff83d73","type":"article","url":"https://hartvaat.nl/2026/03/31/stemi-uitgestelde-primaire-pci-gaat-gepaard-met-hogere-sterfte-dan-trombolyse-ie/","title":"STEMI: uitgestelde primaire PCI gaat gepaard met hogere sterfte dan trombolyse (Iers register)","title_en":"Outcomes according to timely or delayed primary PCI or fibrinolysis in a national registry of STEMI patients","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":["stemi"],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e003886?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e003886?rss=1","authors":["Laffan","J.","Gao","H.","Street","A.","Coughlan","J.","Armstrong","R.","Maree","A.","Blake","G.","Kearney","P.","Crowley","J.","Kiernan","T. J.","McCreery","C.","Aleong","G.","Peace","A.","Kennedy","M.","Byrne","R. A."],"significance":7,"published":"2026-03-31","source_date":"2026-03-31","image":"","kennis":["https://hartvaat.nl/kennis/coronairlijden/stemi/","https://hartvaat.nl/kennis/coronairlijden/esc-richtlijn-acs-2023/"],"congress":"","summary_en":"Time to reperfusion partly determines long-term outcome in ST-elevation myocardial infarction (STEMI). Timely primary PCI is the preferred strategy; fibrinolysis is recommended when timely PCI is not feasible but may be underused. In this nationwide Irish STEMI registry (4,156 patients, 2013-2018), 4.9% received fibrinolysis, 25.8% delayed primary PCI (>120 min after diagnosis) and 69.3% timely primary PCI (<120 min). Over three years' follow-up, delayed primary PCI was associated with higher mortality than fibrinolysis (adjusted HR 1.36), whereas timely PCI gave comparable mortality to fibrinolysis (HR 1.10; not significant). A sizeable proportion of STEMI patients thus still receive delayed PCI — a strategy that fares worse than fibrinolysis. The findings underscore the importance of timely reperfusion and of fibrinolysis when timely PCI is not possible.","created":"2026-07-03T10:32:20Z","updated":"2026-07-03T13:31:17Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De tijd tot reperfusie bepaalt mede de langetermijnuitkomst bij een ST-elevatie-myocardinfarct (STEMI). Tijdige primaire PCI is de voorkeursstrategie; trombolyse wordt aanbevolen wanneer tijdige PCI niet haalbaar is, maar wordt mogelijk te weinig toegepast. In dit landelijke Ierse STEMI-register (4.156 patiënten, 2013-2018) kreeg 4,9% trombolyse, 25,8% uitgestelde primaire PCI (>120 min na diagnose) en 69,3% tijdige primaire PCI (<120 min). Over drie jaar follow-up was uitgestelde primaire PCI geassocieerd met een hogere sterfte dan trombolyse (gecorrigeerde HR 1,36), terwijl tijdige PCI een vergelijkbare sterfte gaf als trombolyse (HR 1,10; niet significant). Een aanzienlijk deel van de STEMI-patiënten krijgt dus nog uitgestelde PCI — een strategie die slechter uitpakt dan trombolyse. De bevindingen onderstrepen het belang van tijdige reperfusie en van trombolyse wanneer tijdige PCI niet mogelijk is.","abstract_original":"<sec><st>Background</st>\n<p>Time to reperfusion is a predictor of long-term outcomes in ST-segment elevation myocardial infarction (STEMI). Timely primary percutaneous coronary intervention (PCI) is the preferred strategy recommended by guidelines. Fibrinolysis is recommended in patients in whom timely primary PCI is not feasible, though concerns persist about underutilisation of this approach. We examined long-term survival outcomes in STEMI patients according to treatment strategy received in a national STEMI registry in Ireland.</p>\n</sec>\n<sec><st>Methods</st>\n<p>This was an observational, nationwide, population-based study. We identified all STEMI cases from January 2013 to March 2018. After exclusion of patients with missing data, we divided patients into three groups as per reperfusion strategy&mdash;fibrinolysis, delayed primary PCI (&gt;120 min of diagnosis) and timely primary PCI (&lt;120 min of diagnosis)&mdash;and analysed mortality through to 3 years follow-up. A multivariate Cox proportional hazards model was used, with a propensity score matching analysis performed as a sensitivity analysis.</p>\n</sec>\n<sec><st>Results</st>\n<p>Of the 4156 patients included in this analysis, 202 (4.9%) were treated with fibrinolysis, 1075 (25.8%) were treated with delayed primary PCI and 2879 (69.3%) were treated with timely primary PCI. At follow-up, delayed primary PCI was associated with an increased risk of mortality through to 3 years in comparison to fibrinolysis (HR<SUB>adjusted</SUB>, 1.36; 95% CI 1.02 to 1.83, p=0.04). Timely primary PCI was associated with a comparable risk of mortality through to 3 years in comparison to fibrinolysis (HR<SUB>adjusted</SUB>, 1.10; 95% CI 0.81 to 1.49, p=0.53).</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>A sizeable proportion of STEMI patients continue to receive treatment with delayed primary PCI. This is associated with an increased risk of mortality through 3 years in comparison to fibrinolysis.</p>\n</sec>"}