Safety and efficacy of a pharmaco-invasive reperfusion strategy in rural ST-elevation myocardial infarction patients with expected delays due to long-distance transfers
Why the study?
Does a pharmaco-invasive reperfusion strategy with half-dose fibrinolysis and transfer for immediate PCI improve outcomes in STEMI patients with expected delays compared to direct presentation for primary PCI?
Population
2634 consecutive STEMI patients, including 660 presenting to remote rural hospitals and 600 presenting…
Comparison
Pharmaco-invasive reperfusion strategy utilizing… vs Direct presentation to the PCI centre for…
Design
Cohort
Follow-up
30 days
Authors
Discussion
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Member takes
Implication
Supports pharmaco-invasive strategy as potential alternative in delayed STEMI transfers; leaves open randomized confirmation before practice change.
Structured PICO
Does a pharmaco-invasive reperfusion strategy with half-dose fibrinolysis and transfer for immediate PCI improve outcomes in STEMI patients with expected delays compared to direct presentation for primary PCI?
P
Population
2634 consecutive STEMI patients, including 660 presenting to remote rural hospitals (≥60 miles away) and 600 presenting directly to the PCI centre.
I
Intervention
Pharmaco-invasive reperfusion strategy utilizing half-dose fibrinolysis combined with transfer for immediate PCI (all received aspirin, clopidogrel, and unfractionated heparin).
C
Comparator
Direct presentation to the PCI centre for primary PCI (received aspirin, clopidogrel, and unfractionated heparin).
O
Outcome
30-day mortality, stroke, major bleeding, and re-infarction/ischaemiahard clinical
A pharmaco-invasive strategy using half-dose fibrinolysis and immediate transfer for PCI appears safe and effective for STEMI patients facing long-distance transfer delays, with outcomes comparable to direct primary PCI.
Cite This Study
Larson et al. (2011) studied this question.