Introduction: The efficacy of primary PCI as well as pharmacoinvasive strategy for revascularization in STEMI patients has been well proven. But in developing countries most of the patients are unable to undergo angiography/PCI within first 24 hrs of presentation. In such patients studies assessing the efficacy of revascularization through extended pharmaco-invasive therapy (fibrinolysis followed by elective PCI between >24 h to 2 weeks of fibrinolytic administration) are sparse.

Aims and objectives: To observe change in LV function as assessed by GLS at 3 months and at 6 months in cohort of STEMI patients undergoing extended pharmaco-invasive therapy.

Materials and Methods: This is a prospective observational study conducted in SCB Medical college, Cuttack. 65 patients who presented with STEMI were included in the study from Nov 2020 to Nov 2021. All the patients underwent thrombolysis with various fibrinolytic agents followed by elective PCI within 24 hrs to 2 weeks. LV function was assessed through Echocardiography (Simpson’s Biplane and GLS) at preprocedure, 3 months and at 6 months.

Results: Mean age of the sample population was 60.18+/- 8.289 years. All of the patients were thrombolysed within a mean window period of 7.57+/-2.744 hrs. The mean time to revascularization was 69.35 +/- 22.97 hrs after thrombolysis. The mean GLS were -11.5+/-3.3, -13.2+/-4.9 and -15.1+/-3.1 at preprocedure, at 3 months follow-up and at 6 months follow-up respectively. When change in mean GLS at 6 months from baseline was compared with respect to the time to PCI, mean change in GLS at 6 months was found to have strong linear correlation with time to PCI after thrombolysis (r=0.773, p<0.01) inferring that though delayed (>24 hrs) still outcomes are better in those in whom PCI was done early i.e., within 48 hrs. (by -4.50) than those in whom PCI was done after 96 hours (by -2.63) of thrombolysis.

Conclusion: Extended pharmaco-invasive strategy is a reasonable option if PCI cannot be performed within the first 24 hours. This strategy is thus likely to widen the window between thrombolysis and PCI. There is a significant improvement of LV function as assessed by GLS at short-term follow-up of 6 months.