Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up.
OBJECTIVE
The CAPTIM (Comparison of primary Angioplasty and Pre-hospital fibrinolysis In acute Myocardial infarction) study found no evidence that a strategy of primary angioplasty was superior in terms of 30-day outcomes to a strategy of pre-hospital fibrinolysis with transfer to an interventional facility in patients managed early at the acute phase of an acute myocardial infarction. The present analysis was designed to compare both strategies at 5 years.


RESULTS
The CAPTIM study included 840 patients managed in a pre-hospital setting within 6 h of an acute ST-segment elevation myocardial infarction. Patients were randomized to either a primary angioplasty (n = 421) or a pre-hospital fibrinolysis (rt-PA) with immediate transfer to a centre with interventional facilities (n = 419). Long-term follow-up was obtained in blinded fashion from 795 patients (94.6%). Using an intent-to-treat analysis, all-cause mortality at 5 years was 9.7% in the pre-hospital fibrinolysis group when compared with 12.6% in the primary angioplasty group [HR 0.75 (95% CI, 0.50-1.14); P = 0.18]. For patients included within 2 h, 5 year mortality was 5.8% in the pre-hospital fibrinolysis group when compared with 11.1% in the primary angioplasty group [HR 0.50 (95% CI, 0.25-0.97); P = 0.04], whereas it was, respectively, 14.5 and 14.4% in patients included after 2 h [HR 1.02, (95% CI 0.59-1.75), P = 0.92].


CONCLUSIONS
The 5-year follow-up is consistent with the 30-day outcomes of the trial, showing similar mortality for primary percutaneous coronary intervention and a policy of pre-hospital lysis followed by transfer to an interventional center. In addition, for patients treated within 2 h of symptom onset, 5-year mortality was lower with pre-hospital lysis.
UMR 5558, Univeristé Lyon 1 et Centre d'Investigation Clinique, Hôpital Cardio-Vasculaire et Pneumologique, Hospices Civils de Lyon, 69394 Lyon Cedex 03, France. eric.bonnefoy-cudraz@chu-lyon.fr
Eric
E
Bonnefoy
Philippe Gabriel
PG
Steg
Florent
F
Boutitie
Pierre-Yves
PY
Dubien
Frédéric
F
Lapostolle
Jérome
J
Roncalli
Frederic
F
Dissait
Gérald
G
Vanzetto
Alain
A
Leizorowicz
Gilbert
G
Kirkorian
C
C
Mercier
E P
EP
McFadden
P
P
Touboul
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000628:therapy; D004632:Emergency Medical Services / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy / Q000628:therapy*; D010360:Patient Transfer; D016019:Survival Analysis; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome