Transportation with very long transfer delays (>90 min) for facilitated PCI with reduced-dose fibrinolysis in patients with ST-segment elevation myocardial infarction: the Krakow Network.
BACKGROUND
The majority of ST-segment elevation myocardial infarction (STEMI) patients are admitted to centers without primary percutaneous coronary intervention (PCI) facilities. Purpose of the study was to determine safety and outcomes in STEMI patients with transfer delay to PCI>90 min receiving half-dose alteplase and abciximab before PCI (facilitated PCI with reduced-dose fibrinolysis).


RESULTS
Outcomes of 669 STEMI patients (<12 h chest pain, non shock, fibrinolysis eligible, <75 years) with transfer delay to PCI>90 min who received half-dose alteplase and full-dose abciximab and were immediately transferred for PCI were compared with primary PCI effects in 1311 patients with transfer delay <90 min. Mean time from symptom-onset to PCI was longer (357 ± 145 min vs. 201 ± 177; P<0.001) in facilitated PCI with reduced-dose fibrinolysis group. In-hospital and 12-month outcomes were similar in both groups, however bleeding events were more frequent in facilitated PCI group (hemorrhagic stroke 0.9% vs. 0%; P<0.001; severe+moderate 5.5% vs. 2.3%; P<0.001).


CONCLUSIONS
This is the first large report showing the safety and benefits of transportation with very long transfer delay (>90 min) for facilitated PCI with reduced-dose fibrinolysis in STEMI patients. In fact, pharmacological treatment (combotherapy) was effective in overcoming the deleterious effects of long time-delay on outcome, with similar survival as compared to short-time transportation, despite higher risk of major bleeding complication.
Dudek
Dariusz
D
Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland. mcdudek@cyf-kr.edu.pl
Dziewierz
Artur
A
Siudak
Zbigniew
Z
Rakowski
Tomasz
T
Zalewski
Jaroslaw
J
Legutko
Jacek
J
Mielecki
Waldemar
W
Janion
Marianna
M
Bartus
Stanislaw
S
Kuta
Marcin
M
Rzeszutko
Lukasz
L
De Luca
Giuseppe
G
Zmudka
Krzysztof
K
Dubiel
Jacek S
JS
D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods; D005260:Female; D005342:Fibrinolysis / Q000187:drug effects / Q000502:physiology*; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006764:Hospitals, Community / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000628:therapy*; D010360:Patient Transfer / Q000379:methods*; D011044:Poland / Q000453:epidemiology; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome
D005343:Fibrinolytic Agents