key: cord-0747301-p9z4a3e3
authors: Leng, Wen-Xiu; Yang, Yue-Jin
title: Reply to a fibrinolysis-first strategy for ST-elevation myocardial infarction in the COVID-19 era
date: 2021-09-25
journal: Int J Cardiol
DOI: 10.1016/j.ijcard.2021.09.043
sha: e23407f14540cbc0aadba7dd5d359a7caceb2a5a
doc_id: 747301
cord_uid: p9z4a3e3

nan

In reply to Jamal et al., our study did not aim to demonstrate the nonsuperiority of fibrinolysis to primary PCI. It is noteworthy that delayed primary PCI if the symptoms persisted and elective PCI if stabilized were integral parts of the fibrinolysis-first strategy. We aimed to stress the overall in-hospital effect of such a 'retrograde' pattern of management (not fibrinolysis only) driven by extreme times when the COVID-19 pandemic hit China first at the beginning of 2020 [1] . Among those patients in whom fibrinolysis was not contraindicated, many refused fibrinolysis therapy for its potential bleeding risk. Besides, we tended to choose thrombolysis more conservatively for those whose symptoms were relieved on presentation, considering restored blood flow of the culprit vessel may be obtained. Since a large proportion (52.4%) of the patients from 2020 underwent elective PCI in a median time of 11 days, their reperfusion delays are obvious and quantitively reporting of D-B time seems unnecessary. Instead, analysis was based on different reperfusion indications according to prehospital delay within 12 h or not. We failed to distinguish PCI after fibrinolysis from others because of the extremely small number of such patients (9 cases), and as Jamal noted, further analysis accounting for confounders were unlikely to be informative for the small sample size. However, the clinical characteristics such as age, Killip classification, and TIMI score etc. were overall matched between patients of the two years.

CSC expert consensus on principles of clinical Management of Patients with Severe Emergent Cardiovascular Diseases during the COVID-19 epidemic

The authors report no relationships that could be construed as a conflict of interest.