title: Transfer for urgent percutaneous coronary intervention early after thrombolysis for ST-elevation myocardial infarction: the TRANSFER-AMI pilot feasibility study.
abstract: 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.
authors.affiliation: Southlake Regional Health Centre, Newmarket, Canada. cantorw@smh.toronto.on.ca
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.forename: Jason
authors.initials: J
authors.lastname: Burnstein
authors.forename: Richard
authors.initials: R
authors.lastname: Choi
authors.forename: Michael
authors.initials: M
authors.lastname: Heffernan
authors.forename: Vladimir
authors.initials: V
authors.lastname: Dzavik
authors.forename: Charles
authors.initials: C
authors.lastname: Lazzam
authors.forename: Marko
authors.initials: M
authors.lastname: Duic
authors.forename: David
authors.initials: D
authors.lastname: Fitchett
authors.forename: Mary
authors.initials: M
authors.lastname: Tan
authors.forename: Janet
authors.initials: J
authors.lastname: Wawrzyniak
authors.forename: Saleem
authors.initials: S
authors.lastname: Kassam
authors.forename: Sanjay
authors.initials: S
authors.lastname: Dhingra
authors.forename: Laurie J
authors.initials: LJ
authors.lastname: Morrison
authors.forename: Anatoly
authors.initials: A
authors.lastname: Langer
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
mesh_terms: 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
chemical_list: D017984:Enoxaparin; D005343:Fibrinolytic Agents; D006493:Heparin; D010959:Tissue Plasminogen Activator; D000077785:Tenecteplase