STEMI Patients Randomized to a Pharmaco-Invasive Strategy or Primary PCI: The STREAM 1-Year Mortality Follow-Up

Background —In the Strategic Reperfusion Early After Myocardial infarction (STREAM) trial, a pharmaco-invasive (PI) strategy was compared to primary PCI (pPCI) in STEMI patients presenting within 3 hours after symptom onset but unable to undergo pPCI within 1 hour. At 30 days, the PI approach was associated with a nominally but non-statistically significant lower incidence of the composite primary endpoint of death, shock, congestive heart failure and reinfarction when compared with pPCI. The aim of the present study was to determine the effect of these strategies on one-year mortality. Methods and Results —Vital status at one year was available in 936 out of 944 (99.2%) and 941 out of 948 (99.3%) patients in the PI and pPCI arm, respectively. At one year, all-cause mortality rates (6.7% vs 5.9%) were similar for PI and pPCI-treated patients (p=0.49, risk ratio (RR)=1.13, 95% CI 0.79-1.62). Cardiac mortality rates were similar as well (4.0% vs 4.1%, p=0.93, RR=0.98, 95% CI 0.62-1.54). Overall, only 34 patients died between day 30 and one year, 20 in the PI arm and 14 in the pPCI arm of whom 20 died of non-cardiac reasons (13 in the PI and 7 in the pPCI arm). There was no significant difference in one-year all-cause mortality between the two groups among the prespecified key subgroups. Conclusions —At one year, mortality rates in the PI and pPCI arms were similar in STEMI patients presenting within 3 hours after symptom onset and unable to undergo pPCI within one hour. Clinical Trial Registration Information —ClinicalTrials.gov. Identifier: NCT00623623.