Comparison of thrombolysis followed by broad use of percutaneous coronary intervention with primary percutaneous coronary intervention for ST-segment-elevation acute myocardial infarction: data from the french registry on acute ST-elevation myocardial infarction (FAST-MI).
BACKGROUND
Intravenous thrombolysis remains a widely used treatment for ST-elevation myocardial infarction; however, it carries a higher risk of reinfarction than primary PCI (PPCI). There are few data comparing PPCI with thrombolysis followed by routine angiography and PCI. The purpose of the present study was to assess contemporary outcomes in ST-elevation myocardial infarction patients, with specific emphasis on comparing a pharmacoinvasive strategy (thrombolysis followed by routine angiography) with PPCI.


RESULTS
This nationwide registry in France included 223 centers and 1714 patients over a 1-month period at the end of 2005, with 1-year follow-up. Sixty percent of the patients underwent reperfusion therapy, 33% with PPCI and 29% with intravenous thrombolysis (18% prehospital). At baseline, the Global Registry of Acute Coronary Events score was similar in thrombolysis and PPCI patients. Time to initiation of reperfusion therapy was significantly shorter in thrombolysis than in PPCI (median 130 versus 300 minutes). After thrombolysis, 96% of patients had coronary angiography, and 84% had subsequent PCI (58% within 24 hours). In-hospital mortality was 4.3% for thrombolysis and 5.0% for PPCI. In patients with thrombolysis, 30-day mortality was 9.2% when PCI was not used and 3.9% when PCI was subsequently performed (4.0% if PCI was performed in the same hospital and 3.3% if performed after transfer to another facility). One-year survival was 94% for thrombolysis and 92% for PPCI (P=0.31). After propensity score matching, 1-year survival was 94% and 93%, respectively.


CONCLUSIONS
When used early after the onset of symptoms, a pharmacoinvasive strategy that combines thrombolysis with a liberal use of PCI yields early and 1-year survival rates that are comparable to those of PPCI.
Danchin
Nicolas
N
Division of Coronary Artery Disease and Intensive Cardiac Care, Hôpital Européen Georges Pompidou, Assistance-Publique des Hôpitaux de Paris and Faculté René Descartes, Université Paris 5, 20 rue Leblanc, 75015 Paris, France. nicolas.danchin@egp.aphp.fr
Coste
Pierre
P
Ferrières
Jean
J
Steg
Philippe-Gabriel
PG
Cottin
Yves
Y
Blanchard
Didier
D
Belle
Loïc
L
Ritz
Bernard
B
Kirkorian
Gilbert
G
Angioi
Michael
M
Sans
Philippe
P
Charbonnier
Bernard
B
Eltchaninoff
Hélène
H
Guéret
Pascal
P
Khalife
Khalife
K
Asseman
Philippe
P
Puel
Jacques
J
Goldstein
Patrick
P
Cambou
Jean-Pierre
JP
Simon
Tabassome
T
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D012042:Registries; D016019:Survival Analysis; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome