Transfer for urgent percutaneous coronary intervention early after thrombolysis for ST-elevation myocardial infarction: the TRANSFER-AMI pilot feasibility study.
BACKGROUND
Most hospitals in Canada do not have percutaneous coronary intervention (PCI) facilities and use thrombolysis as reperfusion therapy for ST-elevation myocardial infarction (STEMI). Urgent PCI after thrombolysis may optimize reperfusion and prevent reinfarction and recurrent ischemia.


OBJECTIVE
To determine the feasibility of transferring high-risk STEMI patients from community hospitals in Ontario to PCI centres for urgent PCI within 6 h of thrombolysis.


METHODS
Patients with anterior or high-risk inferior STEMI received tenecteplase and were urgently transferred to PCI centres. PCI was performed if at least 70% stenosis was present in the infarct-related artery, regardless of flow, using coronary stents. Transfer of stable patients back to community hospitals was encouraged 24 h to 48 h after PCI.


RESULTS
Eighteen patients were transferred and underwent PCI a median of 3.9 h (range 2.7 h to 6.4 h) after thrombolysis. No complications occurred during transfer. One death occurred that was related to failed reperfusion and cardiogenic shock. Minor access-site bleeding occurred in five patients. Fifteen patients were transferred back to their community hospitals within 24 h of PCI. There were no further deaths or reinfarctions at one-year follow-up.


CONCLUSIONS
Transfer of high-risk STEMI patients for urgent PCI within 6 h after thrombolysis appears feasible. The randomized trial phase of the Trial of Routine ANgioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) will compare this strategy with standard treatment after thrombolysis.
Cantor
Warren J
WJ
Southlake Regional Health Centre, Newmarket, Canada. cantorw@smh.toronto.on.ca
Burnstein
Jason
J
Choi
Richard
R
Heffernan
Michael
M
Dzavik
Vladimir
V
Lazzam
Charles
C
Duic
Marko
M
Fitchett
David
D
Tan
Mary
M
Wawrzyniak
Janet
J
Kassam
Saleem
S
Dhingra
Sanjay
S
Morrison
Laurie J
LJ
Langer
Anatoly
A
Goodman
Shaun G
SG
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D017984:Enoxaparin / Q000627:therapeutic use; D005240:Feasibility Studies; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006493:Heparin / Q000627:therapeutic use; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D015425:Myocardial Reperfusion; D009864:Ontario; D010360:Patient Transfer; D010865:Pilot Projects; D011183:Postoperative Complications / Q000209:etiology; D015607:Stents; D000077785:Tenecteplase; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome
D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase