Pentraxin Level is the Key to Determine Primary Percutaneous Coronary Intervention (PCI) or Fibrinolysis

摘要

Aim: To examine if pentraxin can help identifying patients benefitting most from primary Percutaneous Coronary Intervention (PCI) vs. fibrinolysis.Methods: Patients with acute ST-Elevation Myocardial Infarction (STEMI) were consecutively recruited from a community center without PCI and a tertiary center with PCI facilities.Left ventricular ejection fraction (LVEF) was determined echocardiographically at baseline and 5 day after the index admission; the difference between two measurements was considered as the magnitude of improvement. We used regression models to test the hypothesis that the magnitude of the advantage of PCI over fibrinolysis in preserving LVEF 5 days after STEMI is modified by pentraxin 3 (PTX3).Results: The functional advantage (LVEF) of the PCI over fibrinolysis has been determined by PTX3. LVEF attenuated and even reversed as PTX3 level increased. The primary PCI of the participants with less than 7 ng.ml-1 PTX3 level, achieved a clinically significantly increase in the LVEF in compare to fibrinolysis. At lower levels of PTX3, PCI shows a conspicuous advantage over fibrinolysis in terms of the probability of developing a LVEF <40. Conclusion: We demonstrated not only the functional advantage of PCI over fibrinolysis performed within the recommended time frames but also the relative advantage of its relevant to the baseline PTX3 levels. PTX3 can play a role in determining the choice of best therapy. More than 75 of patients with STEMI who have PTX3 levels ≤7 ng.ml-1 implies the need of the PCI.