In-Hospital Outcomes of Primary Percutaneous Coronary Intervention versus Thrombolytic Therapy in ST-Segment Elevation Myocardial Infarction: A Prospective Observational Comparative Study from a Public Sector Hospital in Azad Jammu and Kashmir

Abstract

Objectives: To compare in-hospital outcomes among STEMI patients receiving PPCI versus thrombolytic therapy in a public sector tertiary care hospital in Azad Jammu and Kashmir (AJK). Methodology: This prospective, non-randomized observational comparative study was conducted at the Kashmir Institute of Cardiology, DHQ Hospital Mirpur, AJK, from June to October 2025. A total of 200 consecutive STEMI patients were enrolled and allocated into two equal groups based on time of presentation: PPCI during office hours (8:00 am–2:00 pm) and thrombolysis after hours. Baseline characteristics, door-to-treatment times, reperfusion success, and in-hospital outcomes were recorded. Categorical variables were analyzed using Chi-square and Fisher’s Exact tests, with p<0.05 considered statistically significant. Results: Successful reperfusion was significantly higher in the PPCI group compared to thrombolysis (91% vs. 69%, p<0.001), while failed reperfusion was more frequent in the thrombolysis group (14% vs. 2%, p=0.002). In-hospital mortality was numerically lower with PPCI (2% vs. 8%), though not statistically significant (p=0.052). Overall in-hospital outcomes differed significantly between treatment modalities (p=0.004). Conclusion: PPCI demonstrated superior reperfusion outcomes and a strong trend toward lower in-hospital mortality compared with thrombolytic therapy. These findings support strengthening systems to provide round-the-clock PPCI services in public sector hospitals in AJK, while recognizing limitations inherent to non-randomized allocation and potential confounding.