Primary angioplasty is superior to on-site fibrinolysis in acute myocardial infarction if transfer to the treatment center takes two hours or less.
Does primary angioplasty (including interhospital transfer) reduce the composite of death, reinfarction, or disabling stroke in patients with acute ST-segment elevation myocardial infarction compared to on-site fibrinolysis?
1572 patients with acute myocardial infarction with ST-segment elevation (symptoms for ≥30 minutes but <12 hours, ST-segment elevation ≥4 mm in ≥2 contiguous leads)
Primary angioplasty (including transfer to an invasive-treatment center within 3 hours if admitted to a referral hospital) plus aspirin 300 mg IV, beta-blocker, and unfractionated heparin
Fibrinolysis with accelerated alteplase (15-mg bolus, 0.75 mg/kg over 30 min, 0.5 mg/kg over 60 min) plus aspirin 300 mg orally, beta-blocker, and unfractionated heparin
Composite of death from any cause, clinical reinfarction, or disabling stroke at 30 dayscomposite
Absolute Event Rate: 0% vs 0%
A strategy for reperfusion involving the transfer of patients to an invasive-treatment center for primary angioplasty is superior to on-site fibrinolysis, provided that the transfer takes two hours or less.
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Henning Andersen
University of Copenhagen
Torsten T. Nielsen
Aarhus University Hospital
Klaus Rasmussen
Statistics Denmark
New England Journal of Medicine
Rigshospitalet
Aarhus University Hospital
Odense University Hospital
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Andersen et al. (Wed,) reported a other. Primary angioplasty is superior to on-site fibrinolysis in acute myocardial infarction if transfer to the treatment center takes two hours or less.
synapsesocial.com/papers/6965509fa8efe4f2ad236c0b — DOI: https://doi.org/10.1056/nejmoa025142