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January 1, 2016Clinical CardiologyOpen Access

Rates of in-hospital mortality were 20% for medical therapy alone vs 6.6% for angiography without revascularization vs 2.1% for angiography with revascularization (P < 0.001).

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Why the study?

Does coronary angiography with or without revascularization improve in-hospital mortality compared to medical therapy alone in STEMI patients transferred after receiving fibrinolytic therapy?

Population

18,814 patients with ST-segment elevation myocardial infarction who received fibrinolytic therapy and were…

Comparison

Coronary artery angiography with… vs Medical therapy alone (n=853)

Design

Cohort

Follow-up

in-hospital

Authors

NPNish PatelNPNish PatelNPNileshkumar Patel

Discussion

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Overview

Angiography ± revascularization was associated with lower mortality in post-fibrinolytic STEMI transfers; leaves open causal benefit versus selection bias in randomized trials.

Structured PICO

Does coronary angiography with or without revascularization improve in-hospital mortality compared to medical therapy alone in STEMI patients transferred after receiving fibrinolytic therapy?

P
Population
18,814 patients with ST-segment elevation myocardial infarction (STEMI) who received fibrinolytic therapy and were transferred to a different facility within 24 hours
I
Intervention
Coronary artery angiography with revascularization (n=15,388) or coronary artery angiography without revascularization (n=2,573)
C
Comparator
Medical therapy alone (n=853)
O
Outcome
In-hospital mortalityhard clinical

In STEMI patients transferred after fibrinolytic therapy, undergoing coronary angiography with or without revascularization is associated with significantly lower in-hospital mortality compared to medical therapy alone.

Cite This Study

Patel et al. (2016) studied this question.

synapsesocial.com/papers/6a0faef64fb650da4ffe6429https://doi.org/10.1002/clc.22491
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Fibrinolysis Use Among Patients Requiring Interhospital Transfer for ST-Segment Elevation Myocardial Infarction Care2014 · 79 citations
  2. 2Fibrinolysis Versus Primary Percutaneous Intervention in ST‐elevation Myocardial Infarction With Long Interhospital Transfer Distances2010 · 6 citations
  3. 3Early ST elevation myocardial infarction in non-capable percutaneous coronary intervention centres:<i>in situ</i>fibrinolysis vs. percutaneous coronary intervention transfer2015 · 41 citations
  4. 4Underutilization of Evidence-Based Medications in Acute ST Elevation Myocardial Infarction2002 · 24 citations
  5. 5Outcome up to one year following different reperfusion strategies in acute ST-segment elevation myocardial infarction: The Helsinki-Uusimaa Hospital District registry of ST-Elevation Acute Myocardial Infarction (HUS-STEMI)2013 · 11 citations