Availability of on-site catheterization and clinical outcomes in patients receiving fibrinolysis for ST-elevation myocardial infarction.
OBJECTIVE
To compare management and clinical outcomes in hospitals stratified by the availability of on-site catheterization in InTIME-II, a multicentre trial comparing alteplase with lanoteplase for acute myocardial infarction.


RESULTS
We studied 15,078 patients enrolled in 35 countries and 855 hospitals. Thirty-one percent of hospitals had 24-h, 25% day-only, and 44% no on-site catheterization facilities. Rates of cardiac angiography (57%, 38%, 26%) and revascularization (37%, 21%, 17%) were higher in hospitals with increasing access to on-site facilities(P<0.0001). The presence of a 24-h on-site facility was the strongest predictor of angiography during the index admission (odds ratio 4.17, 95% CI 3.85-4.54). There were no major differences in patient outcomes at 30 days when hospitals were stratified by availability of on-site catheterization. Adjusted 1-year mortality was similar between groups of hospitals (odds ratio for day-only 0.94 [0.80-1.09] and odds ratio for no availability 0.95 [0.83-1.10] compared to hospitals with 24-h facilities).


CONCLUSIONS
There is a marked variation in procedure use by the availability of on-site catheterization with no major differences in patient outcomes. There is a need for additional randomized trials in the current era to address both the appropriate selection of patients and timing of invasive procedures in ST-elevation acute myocardial infarction.
Llevadot
J
J
TIMI Study Group, Cardiovascular Division, Brigham & Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
Giugliano
R P
RP
Antman
E M
EM
Wilcox
R G
RG
Gurfinkel
E P
EP
Henry
T
T
McCabe
C H
CH
Charlesworth
A
A
Thompson
S
S
Nicolau
J C
JC
Tebbe
U
U
Sadowski
Z
Z
Braunwald
E
E
D000293:Adolescent; D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization; D006348:Cardiac Surgical Procedures; D017023:Coronary Angiography; D003625:Data Collection; D004311:Double-Blind Method; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D009204:Myocardial Revascularization; D010343:Patient Admission; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology
D005343:Fibrinolytic Agents