Pre-hospital fibrinolysis followed by angioplasty or primary angioplasty in acute myocardial infarction: the long-term clinical outcome.
BACKGROUND
Randomized trials comparing primary angioplasty and in-hospital fibrinolysis in acute myocardial infarction (AMI) have shown an advantage for primary angioplasty. The long-term follow-up of pre-hospital fibrinolysis followed by elective or rescue coronary angioplasty versus primary angioplasty is not well established after acute myocardial infarction. This study sought to assess the long-term clinical outcome of patients with AMI having either received pre-hospital fibrinolysis optimized by coronary angioplasty or primary angioplasty.


METHODS
We conducted a retrospective analysis involving 318 patients who either underwent primary angioplasty ( n = 157) or received pre-hospital fibrinolysis followed by an angioplasty (rescue or elective) ( n = 161) within 6 hours of the onset of chest pain.


RESULTS
The groups were similar regarding their baseline characteristics except for the ages. No difference was noted for in-hospital mortality (primary PTCA group: 2.48%, combined group: 2.54%; p = ns) with no increased risk of hemorrhage. The 3-year mortality was not significantly different in the two groups (9.7% vs. 4.9%; p = 0.15). Regarding major adverse cardiac events (29.5% vs. 37.5%; p = 0.23), reintervention (22.5% vs. 23.2%; p = 0.99) or target lesion revascularization (16.1% vs. 14.7%; p = 0.68), the groups were statistically similar.


CONCLUSIONS
These data from real-life practice emphasize the safety and similar benefits on the long-term clinical outcome of AMI patients having undergone either pre-hospital fibrinolysis followed by angioplasty or primary angioplasty.
Roncalli
J
J
Cardiology Department, CHU Rangueil, 1 avenue Jean Poulhès, 31403 Toulouse Cedex, France. roncalli.j@chu-toulouse.fr
Brunelle
F
F
Galinier
M
M
Carrié
D
D
Fourcade
J
J
Elbaz
M
M
Gaston
J P
JP
Charpentier
S
S
Puel
J
J
Fauvel
J M
JM
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D004632:Emergency Medical Services; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D016896:Treatment Outcome