Publication details
Long-term outcomes of patients with acute myocardial infarction presenting to hospitals without catheterization laboratory and randomized to immediate thrombolysis or interhospital transport for primary percutaneous coronary intervention.
| Authors | |
|---|---|
| Year of publication | 2007 |
| Type | Article in Periodical |
| Magazine / Source | European Heart Journal |
| MU Faculty or unit | |
| Citation | |
| Doi | http://dx.doi.org/10.1093/eurheartj/ehl535 |
| Field | Cardiovascular diseases incl. cardiosurgery |
| Keywords | Myocardial infarction; Primary coronary intervention; Thrombolysis; Interhospital transport; Long-term outcome |
| Description | Aim Randomized trials in ST elevation myocardial infarction (STEMI) showed improved early outcomes after primary percutaneous coronary intervention (p.PCI) compared with thrombolysis (TL). It is less known whether the early benefit is sustained during the long.term follow.up. Methods and results The PRAGUE 2 trial enrolled 850 STEMI patients presenting to community hospitals without cathlabs within 12 h of symptom onset. Patients were randomized into the groups , TL in community hospital (n = 421) and interhospital transfer for pPCI (n = 429). Follow up data were available in 416 (98.8%) patients in the TL group and 428 (99.8%) in the p.PCI group. At 5 year follow.up, the cumulative incidence of composite endpoint (death from any cause or recurrent infarction or stroke or revascularization) was 53% in TL patients compared with 40% in pPCI patients (HR 1.8; 95% CI 1.38 2.3; P < 0.001). The respective cumulative incidence of death from any cause was 23 and 19% (HR 1.34; 95% CI 0.99 to 1.82; P = 0.06), recurrent infarction 19 vs. 12% (HR 1.72; 95% CI 1.15 to 2.58; P = 0.009), stroke 8 vs. 8% (HR 1.65; 95% CI 0.84 to 2.23; P = 0.18), revascularization 51 vs. 34% (HR 1.81; 95% CI 1.21 to 2.35; P < 0.001). Conclusion The early benefit from the p.PCI strategy (over TL) is sustained during the 5 years follow.up. It can be almost exclusively derived from differences in event rate during the first month. |