title: 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.
abstract: 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.
authors.affiliation: Department of Interventional Cardiology, Jagiellonian University Medical College, Krakow, Poland. mcdudek@cyf-kr.edu.pl
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Siudak
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Jaroslaw
authors.initials: J
authors.lastname: Zalewski
authors.forename: Jacek
authors.initials: J
authors.lastname: Legutko
authors.forename: Waldemar
authors.initials: W
authors.lastname: Mielecki
authors.forename: Marianna
authors.initials: M
authors.lastname: Janion
authors.forename: Stanislaw
authors.initials: S
authors.lastname: Bartus
authors.forename: Marcin
authors.initials: M
authors.lastname: Kuta
authors.forename: Lukasz
authors.initials: L
authors.lastname: Rzeszutko
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zmudka
authors.forename: Jacek S
authors.initials: JS
authors.lastname: Dubiel
mesh_terms: 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
chemical_list: D005343:Fibrinolytic Agents