title: Long-term outcomes of patients with acute myocardial infarction presenting to hospitals without catheterization laboratory and randomized to immediate thrombolysis or interhospital transport for primary percutaneous coronary intervention. Five years' follow-up of the PRAGUE-2 Trial.
abstract: OBJECTIVE
  Randomized trials in ST-elevation myocardial infarction (STEMI) showed improved early outcomes after primary percutaneous coronary intervention (p-PCI) compared with thrombolysis (TL). It is less known whether the early benefit is sustained during the long-term follow-up.
  
  
  RESULTS
  The PRAGUE-2 trial enrolled 850 STEMI patients presenting to community hospitals without cath-labs within 12 h of symptom onset. Patients were randomized into the groups 'TL in community hospital' (n = 421) and 'interhospital transfer for p-PCI' (n = 429). Follow-up data were available in 416 (98.8%) patients in the TL group and 428 (99.8%) in the p-PCI group. At 5 year follow-up, the cumulative incidence of composite endpoint (death from any cause or recurrent infarction or stroke or revascularization) was 53% in TL patients compared with 40% in p-PCI patients (HR 1.8; 95% CI 1.38-2.33; P < 0.001). The respective cumulative incidence of death from any cause was 23 and 19% (HR 1.34; 95% CI 0.99-1.82; P = 0.06), recurrent infarction 19 vs. 12% (HR 1.72; 95% CI 1.15-2.58; P = 0.009), stroke 8 vs. 8% (HR 1.65; 95% CI 0.84-2.23; P = 0.18), revascularization 51 vs. 34% (HR 1.81; 95% CI 1.21-2.35; P < 0.001).
  
  
  CONCLUSIONS
  The early benefit from the p-PCI strategy (over TL) is sustained during the 5 years' follow-up. It can be almost exclusively derived from differences in event rate during the first month.
authors.affiliation: Cardiocenter Vinohrady, Third Faculty of Medicine, Charles University, Srobarova 50, Prague, Czech Republic. widim@fnkv.cz
authors.forename: Petr
authors.initials: P
authors.lastname: Widimsky
authors.forename: Dana
authors.initials: D
authors.lastname: Bilkova
authors.forename: Martin
authors.initials: M
authors.lastname: Penicka
authors.forename: Martin
authors.initials: M
authors.lastname: Novak
authors.forename: Miroslava
authors.initials: M
authors.lastname: Lanikova
authors.forename: Vladimir
authors.initials: V
authors.lastname: Porizka
authors.forename: Ladislav
authors.initials: L
authors.lastname: Groch
authors.forename: Michael
authors.initials: M
authors.lastname: Zelizko
authors.forename: Tomas
authors.initials: T
authors.lastname: Budesinsky
authors.forename: Michael
authors.initials: M
authors.lastname: Aschermann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000401:mortality*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010360:Patient Transfer; D011379:Prognosis; D012008:Recurrence; D015912:Thrombolytic Therapy / Q000379:methods* / Q000401:mortality