title: 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).
abstract: 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.
authors.affiliation: 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
authors.forename: Nicolas
authors.initials: N
authors.lastname: Danchin
authors.forename: Pierre
authors.initials: P
authors.lastname: Coste
authors.forename: Jean
authors.initials: J
authors.lastname: Ferrières
authors.forename: Philippe-Gabriel
authors.initials: PG
authors.lastname: Steg
authors.forename: Yves
authors.initials: Y
authors.lastname: Cottin
authors.forename: Didier
authors.initials: D
authors.lastname: Blanchard
authors.forename: Loïc
authors.initials: L
authors.lastname: Belle
authors.forename: Bernard
authors.initials: B
authors.lastname: Ritz
authors.forename: Gilbert
authors.initials: G
authors.lastname: Kirkorian
authors.forename: Michael
authors.initials: M
authors.lastname: Angioi
authors.forename: Philippe
authors.initials: P
authors.lastname: Sans
authors.forename: Bernard
authors.initials: B
authors.lastname: Charbonnier
authors.forename: Hélène
authors.initials: H
authors.lastname: Eltchaninoff
authors.forename: Pascal
authors.initials: P
authors.lastname: Guéret
authors.forename: Khalife
authors.initials: K
authors.lastname: Khalife
authors.forename: Philippe
authors.initials: P
authors.lastname: Asseman
authors.forename: Jacques
authors.initials: J
authors.lastname: Puel
authors.forename: Patrick
authors.initials: P
authors.lastname: Goldstein
authors.forename: Jean-Pierre
authors.initials: JP
authors.lastname: Cambou
authors.forename: Tabassome
authors.initials: T
authors.lastname: Simon
mesh_terms: 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