Transportation with very long transfer delays (>90 min) for facilitated PCI with reduced-dose fibrinolysis in patients with ST-segment elevation myocardial infarction: the Krakow Network.

Abstract

BACKGROUND:

The majority of ST-segment elevation myocardial infarction (STEMI) patients are admitted to centers without primary percutaneous coronary intervention (PCI) facilities. Purpose of the study was to determine safety and outcomes in STEMI patients with transfer delay to PCI>90 min receiving half-dose alteplase and abciximab before PCI (facilitated PCI with reduced-dose fibrinolysis).

METHODS AND RESULTS:

Outcomes of 669 STEMI patients (<12 h chest pain, non shock, fibrinolysis eligible, <75 years) with transfer delay to PCI>90 min who received half-dose alteplase and full-dose abciximab and were immediately transferred for PCI were compared with primary PCI effects in 1311 patients with transfer delay <90 min. Mean time from symptom-onset to PCI was longer (357 ± 145 min vs. 201 ± 177; P<0.001) in facilitated PCI with reduced-dose fibrinolysis group. In-hospital and 12-month outcomes were similar in both groups, however bleeding events were more frequent in facilitated PCI group (hemorrhagic stroke 0.9% vs. 0%; P<0.001; severe+moderate 5.5% vs. 2.3%; P<0.001).

CONCLUSIONS:

This is the first large report showing the safety and benefits of transportation with very long transfer delay (>90 min) for facilitated PCI with reduced-dose fibrinolysis in STEMI patients. In fact, pharmacological treatment (combotherapy) was effective in overcoming the deleterious effects of long time-delay on outcome, with similar survival as compared to short-time transportation, despite higher risk of major bleeding complication.

• Authors: Dariusz Dudek, Artur Dziewierz, Zbigniew Siudak, Tomasz Rakowski, Jaroslaw Zalewski, Jacek Legutko, Waldemar Mielecki, Marianna Janion, Stanislaw Bartus, Marcin Kuta, Lukasz Rzeszutko, Giuseppe De Luca, Krzysztof Zmudka, Jacek S Dubiel
• Journal: International journal of cardiology (Int J Cardiol) Vol. 139 Issue 3 Pg. 218-27 (Mar 18 2010) ISSN: 1874-1754 [Electronic] Netherlands
• PMID: 19036463 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2008. Published by Elsevier Ireland Ltd.

Chemical References

• Fibrinolytic Agents

Topics

• Aged
• Angioplasty, Balloon, Coronary (methods)
• Female
• Fibrinolysis (drug effects, physiology)
• Fibrinolytic Agents (administration & dosage)
• Follow-Up Studies
• Hospitals, Community (methods)
• Humans
• Male
• Middle Aged
• Myocardial Infarction (epidemiology, therapy)
• Patient Transfer (methods)
• Poland (epidemiology)
• Registries
• Time Factors
• Treatment Outcome