November 8, 2011Circulation
Benefit of Transferring ST-Segment–Elevation Myocardial Infarction Patients for Percutaneous Coronary Intervention Compared With Administration of Onsite Fibrinolytic Declines as Delays Increase
Why the study?
Does transfer for primary PCI improve in-hospital mortality compared with onsite fibrinolytic therapy in STEMI patients as PCI-related delays increase?
Population
19,012 propensity-matched ST-segment-elevation myocardial infarction patients enrolled in the National…
Comparison
Transfer for primary percutaneous coronary… vs Administration of onsite fibrinolytic therapy
Design
Cohort
Follow-up
in-hospital
Authors
Discussion
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Member takes
Implication
May negate transfer PCI benefit beyond 120-minute delay; hypothesis-generating in observational STEMI data and needs prospective confirmation.
Structured PICO
Does transfer for primary PCI improve in-hospital mortality compared with onsite fibrinolytic therapy in STEMI patients as PCI-related delays increase?
P
Population
19,012 propensity-matched ST-segment-elevation myocardial infarction patients enrolled in the National Registry of Myocardial Infarction (NRMI) within 12 hours of pain onset (9,506 X-PCI, 9,506 O-FT).
I
Intervention
Transfer for primary percutaneous coronary intervention (X-PCI)
C
Comparator
Administration of onsite fibrinolytic therapy (O-FT)
O
Outcome
In-hospital mortalityhard clinical
The mortality benefit of transferring STEMI patients for primary PCI compared to onsite fibrinolysis is lost when PCI-related delays exceed 120 minutes.
Cite This Study
Pinto et al. (2011) studied this question.