Prospects for a pharmacoinvasive strategy in ST-elevation myocardial infarction in the Russian Federation
https://doi.org/10.15829/1560-4071-2025-6290
EDN: FPPJBP
Abstract
In patients with ST-elevation myocardial infarction, primary percutaneous coronary intervention should be performed within 120 minutes after diagnosis if possible. Timely revascularization helps to preserve left ventricular function, minimizing myocardial damage, which subsequently reduces disability and mortality. There are patients for whom this approach cannot be implemented within the specified time frame for a number of reasons. In such a situation, a pharmacoinvasive strategy is recommended, which involves thrombolytic therapy as the first stage. Current treatment strategies for myocardial infarction have been compared many times. An undoubted advantage in Russia is the availability of domestic staphylokinase agent, which has a good efficacy and safety profile, meeting the requirements for fibrin specificity. Thus, research determining the current place of pharmacoinvasive strategy should be continued to optimize thrombolysis and improve the prognosis in patients with myocardial infarction.
About the Authors
V. E. Oleynikov
Penza State University
Russian Federation
Competing Interests:
Russian Federation
Penza
Competing Interests:
нет
R. M. Shakhnovich
Chazov National Medical Research Center of Cardiology
Russian Federation
Competing Interests:
Russian Federation
Moscow
Competing Interests:
нет
A. N. Yakovlev
Almazov National Medical Research Center
Russian Federation
Competing Interests:
Russian Federation
St. Petersburg
Competing Interests:
нет
R. M. Rabinovich
Tver Regional Clinical Hospital
Russian Federation
Competing Interests:
Russian Federation
Tver
Competing Interests:
нет
I. V. Avdeeva
Penza State University
Russian Federation
Competing Interests:
Russian Federation
Penza
Competing Interests:
нет
References
1. Byrne RA, Rossello X, Coughlan JJ, et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal. 2023;44(38):3720-826. doi: 10.1093/eurheartj/ehad191.
2. 2020 Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(11):4103. (In Russ.) doi: 10.15829/1560-4071-2020-4103.
3. Pinto DS, Kirtane AJ, Nallamothu BK, et al. Hospital delays in reperfusion for ST-elevation myocardial infarction: implications when selecting a reperfusion strategy. Circulation. 2006;114:2019-25. doi: 10.1161/circulationaha.106.638353.
4. Nallamothu BK, Bates ER. Percutaneous coronary intervention versus fibrinolytic therapy in acute myocardial infarction: is timing (almost) everything? Am J Cardiol. 2003;92: 824-6. doi: 10.1016/s0002-9149(03)00891-9.
5. Betriu A, Masotti M. Comparison of mortality rates in acute myocardial infarction treated by percutaneous coronary intervention versus fibrinolysis. Am J Cardiol. 2005;95:100-1. doi: 10.1016/j.amjcard.2004.08.069.
6. Boersma E. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. European Heart Journal. 2006;27:779-8. doi: 10.1093/eurheartj/ehi810.
7. Pinto DS, Frederick PD, Chakrabarti AK, et al. Benefit of transferring ST-segment-elevation myocardial infarction patients for percutaneous coronary intervention compared with administration of onsite fibrinolytic declines as delays increase. Circulation. 2011;124:2512-21. doi: 10.1161/circulationaha.111.018549.
8. Armstrong PW, Gershlick AH, Goldstein P, et al. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013;368:1379-87. doi: 10.1056/NEJMoa1301092.
9. Keeley EC, Boura JA, Grines CL. Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet. 2003;361:13-20. doi: 10.1016/s0140-6736(03)12113-7.
10. Huynh T, Perron S, O'Loughlin J, et al. Comparison of primary percutaneous coronary intervention and fibrinolytic therapy in ST-segment-elevation myocardial infarction: Bayesian hierarchical meta-analyses of randomized controlled trials and observational studies. Circulation. 2009;119:3101-9. doi: 10.1161/circulationaha.108.793745.
11. Writing Committee Members, Antman EM, Anbe DT, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction—Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction). Journal of the American College of Cardiology. 2004;44(3);671-719. doi: 10.1016/j.jacc.2004.07.002.
12. Writing Committee Members, O'Gara PT, Kushner FG, et al. 2013 ACCF/AHA Guideline for the Management of ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013;127(4):e362-e425. doi: 10.1161/CIR.0b013e3182742cf6.
13. Steg G, James SK, Atar D, et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012; 33(20):2569-619. doi: 10.1093/eurheartj/ehs215.
14. Ibanez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). Eur Heart J. 2018;39(2): 119-77. doi: 10.1093/eurheartj/ehx393.
15. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. Lancet. 1994;343(8893):311-22. doi: 10.1016/S0140-6736(94)91161-4.
16. Le May MR, Wells GA, Labinaz M, et al. Combined Angioplasty and Pharmacological Intervention Versus Thrombolysis Alone in Acute Myocardial Infarction (CAPITAL-AMI Study). Journal of the American College of Cardiology. 2005;46(3):417-24. doi: 10.1016/j.jacc.2005.04.042.
17. Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial. Lancet. 2006;367(9510):569-78. doi: 10.1016/S0140-6736(06)68147-6.
18. Steg PG, Danchin N. WEST: new data on the integration of early thrombolysis and mechanical intervention in the early management of STEMI. European Heart Journal. 2006;27(13):1511-2. doi: 10.1093/eurheartj/ehl107.
19. Fernández-Avilés F, Alonso JJ, Castro-Beiras A, et al. Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial. Lancet. 2004;364(9439):1045-53. doi: 10.1016/S0140-6736(04)17059-1.
20. Fernández-Avilés F, Alonso JJ, Peña G, et al. Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial infarction with ST-segment elevation: the GRACIA-2 non-inferiority, randomized, controlled trial. European Heart Journal. 2007;28(8):949-60. doi: 10.1093/eurheartj/ehl461.
21. Arbel Y, Ko DT, Yan AT, et al. Long-term Follow-up of the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI). Can J Cardiol. 2018;34(6):736-43. doi: 10.1016/j.cjca.2018.02.005.
22. Bøhmer E, Hoffmann P, Abdelnoor M, et al. Efficacy and safety of immediate angioplasty versus ischemia-guided management after thrombolysis in acute myocardial infarction in areas with very long transfer distances results of the NORDISTEMI (NORwegian study on DIstrict treatment of ST-elevation myocardial infarction). J Am Coll Cardiol. 2010;55(2):102-10. doi: 10.1016/j.jacc.2009.08.007.
23. Armstrong PW, Gershlick A, Goldstein P, et al. The Strategic Reperfusion Early After Myocardial Infarction (STREAM) study. Am Heart J. 2010;160(1):30.e1-35.e1. doi: 10.1016/j.ahj.2010.04.007.
24. Van de Werf F, Ristić AD, Averkov OV, et al. STREAM-2: Half-Dose Tenecteplase or Primary Percutaneous Coronary Intervention in Older Patients With ST-Segment-Elevation Myocardial Infarction: A Randomized, Open-Label Trial. Circulation. 2023;148(9):753-64. doi: 10.1161/CIRCULATIONAHA.123.064521.
25. Stone GW, Gersh BJ. Facilitated angioplasty: paradise lost. Lancet. 2006;367(9510): 543-6. doi:10.1016/S0140-6736(06)68149-X.
26. Singh KP, Roe MT. ASSENT-4 PCI: should facilitated percutaneous coronary intervention be used in clinical practice? Nat Clin Pract Cardiovasc Med. 2006;3(8):420-1. doi: 10.1038/ncpcardio0626.
27. Fazel R, Joseph TI, Sankardas MA, et al. Comparison of Reperfusion Strategies for ST-Segment-Elevation Myocardial Infarction: A Multivariate Network Meta-analysis. J Am Heart Assoc. 2020;9(12):e015186. doi: 10.1161/JAHA.119.015186.
28. Li K, Zhang B, Zheng B, et al. Reperfusion Strategy of ST-Elevation Myocardial Infarction: A Meta-Analysis of Primary Percutaneous Coronary Intervention and Pharmaco-Invasive Therapy. Front Cardiovasc Med. 2022;9:813325. doi: 10.3389/fcvm.2022.813325.
29. Bainey KR, Armstrong PW, Zheng Y, et al. Pharmacoinvasive Strategy Versus Primary Percutaneous Coronary Intervention in ST-Elevation Myocardial Infarction in Clinical Practice. Circulation: Cardiovascular Interventions. 2019;12:e008059. doi: 10.1161/CIRCINTERVENTIONS.119.008059.
30. Wong GC, Welsford M, Ainsworth C, et al. 2019 Canadian Cardiovascular Society/Canadian Association of Interventional Cardiology Guidelines on the Acute Management of ST-Elevation Myocardial Infarction: Focused Update on Regionalization and Reperfusion. Canadian Journal of Cardiology. 2019;35(2):107-32. doi: 10.1016/j.cjca.2018.11.031.
31. Danchin N, Popovic B, Puymirat E, et al. Five-year outcomes following timely primary percutaneous intervention, late primary percutaneous intervention, or a pharmacoinvasive strategy in ST-segment elevation myocardial infarction: the FAST-MI programme. European Heart Journal. 2020;41(7):858-66. doi: 10.1093/eurheartj/ehz665.
32. Jortveit J, Pripp AH, Halvorsen S, et al. Outcomes after delayed primary percutaneous coronary intervention vs. pharmaco-invasive strategy in ST-segment elevation myocardial infarction in Norway. Eur Heart J Cardiovasc Pharmacother. 2022;8(5):442-51. doi: 10.1093/ehjcvp/pvab041.
33. Jamal J, Idris H, Faour A, et al. Late outcomes of ST-elevation myocardial infarction treated by pharmaco-invasive or primary percutaneous coronary intervention. Eur Heart J. 2023;44(6):516-28. doi: 10.1093/eurheartj/ehac661.
34. Hohlunov SM, Prozhoga MG, Gureev AD. Pharmacoinvasive strategy in the treatment of acute coronary syndrome with ST segment elevation on ECG. News of the Samara Scientific Center of the Russian Academy of Sciences. 2015;17(2):404-10. (In Russ.)
35. Boytsov SA, Shakhnovich RM, Tereschenko SN, et al. Features of the Reperfusion Therapy for ST-Segment Elevation Myocardial Infarction According to the Russian Registry of Acute Myocardial Infarction — REGION-IM. Kardiologiia. 2024;64(2):3-17. (In Russ.) doi: 10.18087/cardio.2024.2.n2601.
36. Erlikh AD, Gratsiansky NA on behalf of the participants of the register RECORD 3. Russian registry of acute coronary syndrome RECORD-3. Characteristics of patients and treatment before discharge from hospital. Cardiologiia. 2016;56(4):16-24. (In Russ.)
37. Acute myocardial infarction with ST segment elevation of electrocardiogram. Russian Journal of Cardiology. 2025;30. Ahead of print. (In Russ.)
38. Kumar A, Vora K, Bhatt DL, et al. The Canadian Cardiovascular Society Classification of acute atherothrombotic myocardial infarction provides a novel staging scheme based on tissue injury severity. Eur Heart J. 2024;45(12):976-9. doi: 10.1093/eurheartj/ehad821.
39. Steg PG, Bonnefoy E, Chabaud S, et al. Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) Investigators. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation. 2003;108(23):2851-6. doi: 10.1161/01.CIR.0000103122.10021.F2.
40. Maleki ND, Van de Werf F, Goldstein P, et al. Aborted myocardial infarction in ST-elevation myocardial infarction: insights from the STrategic Reperfusion Early After Myocardial infarction trial. Heart. 2014;100(19):1543-9. doi: 10.1136/heartjnl-2014-306023.
41. Marcolino MS, Maia LM, Oliveira JAQ, et al. Impact of telemedicine interventions on mortality in patients with acute myocardial infarction: A systematic review and metaanalysis. Heart. 2019;105:1479-86. doi: 10.1136/heartjnl-2018-314539.
42. de Waure C, Cadeddu C, Gualano MR, et al. Telemedicine for the reduction of myocardial infarction mortality: A systematic review and a meta-analysis of published studies. Telemed J E Health. 2012;18:323-8. doi: 10.1089/tmj.2011.0158.
43. Gatsko YuS, Nokhrin AV, Urvantseva IA, et al. Organization of remote consultation and routing of patients with cardiovascular pathology in the conditions of Khanty-Mansi Autonomous Okrug-Yugra. Current problems of health care and medical statistics. 2017;4:200-1. (In Russ.)
44. Neumann F-J, Sousa-Uva M, Ahlsson A, et al. 2018 ESC/EACTS Guidelines on myocardial revascularization. European Heart Journal. 2019;40,87-165. doi: 10.1093/eurheartj/ehy394.
45. Tereshchenko AS, Zhamgyrchiev ShT, Merkulov EV, et al. Transradial approach during percutaneous coronary interventions. Part 2. Practical guidelines and the authors' data. Journal of radiology and nuclear medicine. 2014;(2):52-9. (In Russ.) doi: 10.20862/0042-4676-2014-0-2-52-59.
46. Chen P, Eikelboom JW, Tan C, et al. Single Bolus r-SAK Before Primary PCI for ST-Segment—Elevation Myocardial Infarction. Circulation: Cardiovascular Interventions. 2024; 17(2):e013455. doi: 10.1161/CIRCINTERVENTIONS.123.013455.
47. Li C, Eikelboom JW, Zhong Z, et al. Efficacy and safety of a bolus of half-dose r-SAK prior to primary PCI in ST-elevation myocardial infarction: Rationale and design of the OPTIMA-6 trial. Am Heart J. 2023;265:31-9. doi: 10.1016/j.ahj.2023.06.012.
48. Averkov OV. Thrombolytic therapy for myocardial infarction. Lechebnoe delo. 2003; 1:21-33. (In Russ.)
49. Markov VA, Duplyakov DV, Konstantinov SL, et al. Advanced results of Fortelyzin® use in the FRIDOM1 study and real clinical practice. Russian Journal of Cardiology. 2022;27(8):5178. (In Russ.) doi: 10.15829/1560-4071-2022-5178.
50. Markov VA, Duplyakov DV, Konstantinov SL, et al. Fortelyzin® in comparison with Metalyse® for ST-elevated myocardial infarction: one-year results and clinical outcomes of a multicenter randomized study FRIDOM1. Russian Journal of Cardiology. 2018;(11):110-6. (In Russ.) doi: 10.15829/1560-4071-2018-11-110-116.
51. Kalinina AM, Gomova TA, Kushunina DV, et al. Prophylactic activity of outpatients as an important factor of the efficiency of prophylactic medical examination and case follow-up: Regional experience. Russian Journal of Preventive Medicine. 2015;18(2): 4-10. (In Russ.) doi: 10.17116/profmed20151824-1.
52. Mican J, Toul M, Bednar D, et al. Structural Biology and Protein Engineering of Thrombolytics. Computational and Structural Biotechnology. 2019;17:917-38. doi: 10.1016/j.csbj.2019.06.023.
Supplementary files
Review
For citations:
Oleynikov V.E., Shakhnovich R.M., Yakovlev A.N., Rabinovich R.M., Avdeeva I.V. Prospects for a pharmacoinvasive strategy in ST-elevation myocardial infarction in the Russian Federation. Russian Journal of Cardiology. 2025;30(3):6290. (In Russ.) https://doi.org/10.15829/1560-4071-2025-6290. EDN: FPPJBP
Views:
139
Email this article 