1-Year Survival in a Randomized Trial of Facilitated Reperfusion

• Published in: JACC. Cardiovascular interventions 2009-10, Vol.2 (10), p.909-916
• Main Authors: Ellis, Stephen G., MD, Tendera, Michal, MD, de Belder, Mark A., MD, van Boven, Ad J., MD, Widimsky, Petr, MD, Andersen, Henning R., MD, Betriu, Amadeo, MD, Savonitto, Stefano, MD, Adamus, Jerzy, MD, Peruga, Jan Z., MD, Hamankiewicz, Maciej, MD, Pluta, Waladyslaw, MD, Oldroyd, Keith, MD, Ecollan, Patrick, MD, Janssens, Luc, MD, Armstrong, Paul, MD, Brodie, Bruce R., MD, Herrmann, Howard C., MD, Montalescot, Gilles, MD, Neumann, Franz-Josef, MD, Effron, Mark B., MD, Barnathan, Elliot S., MD, Topol, Eric J., MD
• Format: Article
• Language: English
• Subjects: acute myocardial infarction; Cardiovascular; primary percutaneous coronary intervention; reperfusion therapy
• ISSN: 1936-8798; 1876-7605
• DOI: 10.1016/j.jcin.2009.07.009

Objectives The aim of this report was to evaluate 12-month outcomes of facilitated percutaneous coronary intervention (PCI) in the FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) trial. Background Treatment delays remain common for patients with primary PCI leading to studies evaluating possible benefit of “facilitated” PCI. In the FINESSE trial, no reduction in the 90-day primary ischemic end point and an increase in bleeding were observed with both facilitated approaches, although modest favorable trends were seen for some patient subgroups. Methods A total of 2,452 patients with ST-segment elevation myocardial infarction (MI) and anticipated 1 to 4 h delay until catheterization were randomized to reduced-dose reteplase + abciximab, abciximab alone, or placebo, followed by expedited primary PCI. Placebo-treated patients received abciximab in the cath lab. One-year mortality was a pre-specified secondary end point. Results One-year mortalities in the 3 groups noted in the preceding text were 6.3%, 7.4%, and 7.0%, respectively (p = NS), representing 1.1%, 1.9%, and 2.5% increments since the 90-day outcome (p = 0.053 for combination treatment vs. primary PCI). A favorable trend with combination treatment was seen for patients with anterior MI (p = 0.09), but no other specified groups benefited or tended to benefit. Independent baseline correlates of 1-year mortality were systolic blood pressure 1, anterior MI, body mass index ≤25 kg/m2 , heart rate >100 beats/min, and no statin use. Conclusions These results suggest that widespread utilization of the facilitated approaches tested cannot be justified, but that high-risk patient groups such as patients with anterior MI may deserve further study. (The FINESSE trial; NCT00046228 )