Differences in Coronary Grade Flow in Diagnostic Coronary Angiography Between Half Dose and Full Dose Pharmacoinvasive Strategy in Patients with ST-Elevation Myocardial Infarction (STEMI)

Abstract

Background: The time for managing patient with STEMI undergoing primary PCI strategy in indonesia has not yet achieved the ideal target < 90 minutes. Considering the risk of bleeding from fibrinolysis strategy, despite being part of the pharmacoinvasive strategy. Half dose pharmacoinvasive strategy was developed to address these limitations and its expected to give the same result as full dose pharmacoinvasive strategy

Objectives: To determine the diferences in coronary grade flow in diagnostic coronary angiography procedure between half dose pharmacoinvasive strategy and full dose pharmacoinvasive strategy in patients with STEMI

Methods: This study is an observational study with retrospective cohort design to determine the differences in coronary flow grade in diagnostic coronary angiography procedure between half dose pharmacoinvasive strategy and full dose pharmacoinvasive strategy in patients with STEMI using secondary data from SHERIVE study between February 2021 until march 2025. Coronary flow grade was assessed based on diagnostic coronary angiography and grouped into TIMI grade 3 flow as coronary flow patency  dan TIMI grade 0-2 flow (not TIMI grade 3 flow)  

Result: There were 151 subjects who met the inclusion and exclusion criteria: 75 subjects in the half dose pharmacoinvasive strategy and 76 subjects in full dose pharmacoinvasive strategy. Bivariate analysis showed a significant difference in the degree of TIMI grade 3 flow between the half dose pharmacoinvasive strategy and the full dose pharmacoinvasive strategy, 33.33 % vs 52.63 % respectively (RR 0,633; IK 95 % 0,431-0,930;p=0,017). Multivariate analysis also found that the halfdose pharmacoinvasive strategy was an independent predictor of TIMI grade 3 flow (RR 0.377; 95% CI 0.185-0.765; p=0.007). Other independent predictors of achieving TIMI grade 3 flow included administration of ACE inhibitors/ARBs (RR 0.303; 95% CI 0.141-0.654; p=0.002)

Conclusion: There is a significant difference in TIMI grade 3 flow in diagnostic coronary angiography procedure between patients with STEMI undergoing half dose pharmacoinvasive strategy and full dose pharmacoinvasive strategy.