Comparison of pre-hospital combination-fibrinolysis plus conventional care with pre-hospital combination-fibrinolysis plus facilitated percutaneous coronary intervention in acute myocardial infarction

Aims Early and complete reperfusion is the main treatment goal in ST-elevation myocardial infarction (STEMI). The timely optimal reperfusion strategy might be a pre-hospital initiated pharmacological reperfusion with subsequent facilitated percutaneous coronary intervention (PCI). This approach has...

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Bibliographic Details
Published in:European heart journal 2005-10, Vol.26 (19), p.1956-1963
Main Authors: Thiele, Holger, Engelmann, Lothar, Elsner, Kathleen, Kappl, Mathias J., Storch, Wulf-Hinrich, Rahimi, Kazem, Hartmann, Andreas, Pfeiffer, Dietrich, Kneissl, Georg D., Schneider, Dieter, Möller, Thomas, Heberling, Hans J., Weise, Ina, Schuler, Gerhard
Format: Article
Language:English
Subjects:
Acute myocardial infarction
Adult
Aged
Angioplasty, Balloon, Coronary - methods
Biological and medical sciences
Cardiology. Vascular system
Combined Modality Therapy
Coronary heart disease
Emergency Medical Services - methods
Emergency Treatment
Facilitated angioplasty
Female
Fibrinolysis
Heart
Hospitalization
Humans
Magnetic Resonance Angiography
Male
Medical sciences
Middle Aged
Myocardial Infarction - mortality
Myocardial Infarction - pathology
Myocardial Infarction - therapy
Myocarditis. Cardiomyopathies
Percutaneous coronary intervention
Pre-hospital treatment
Thrombolytic Therapy - methods
Time Factors
Treatment Outcome
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Summary:Aims Early and complete reperfusion is the main treatment goal in ST-elevation myocardial infarction (STEMI). The timely optimal reperfusion strategy might be a pre-hospital initiated pharmacological reperfusion with subsequent facilitated percutaneous coronary intervention (PCI). This approach has been compared with pre-hospital combination-fibrinolysis only to determine whether either one of these methods offer advantages with respect to final infarct size. Methods and results Patients with STEMI were randomized to either pre-hospital combination-fibrinolysis (half-dose reteplase+abciximab) with standard care (n=82) or pre-hospital combination-fibrinolysis with facilitated PCI (n=82). Primary endpoint was the infarct size assessed by delayed enhancement magnetic resonance. Secondary endpoints were ST-segment resolution at 90 min and a composite of death, re-myocardial infarction, major bleeding, and stroke at 6 months. The infarct size was lower after facilitated PCI with 5.2% [interquartile range (IQR) 1.3–11.2] as opposed to 10.4% (IQR 3.4–16.3) after pre-hospital combination-fibrinolysis (P=0.001). Complete ST-segment resolution was 80.0% after facilitated PCI vs. 51.9% after pre-hospital combination-fibrinolysis (P
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehi432