title: Efficacy and safety of a routine early invasive strategy in relation to time from symptom onset to fibrinolysis (a subgroup analysis of TRANSFER-AMI).
abstract: The aim of this study was to assess the efficacy and safety of an early invasive strategy post-fibrinolysis in relation to time from symptom onset to fibrinolysis in patients with ST-elevation myocardial infarction (STEMI). The Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) randomized 1,059 patients receiving fibrinolysis for STEMI to an early invasive strategy versus standard therapy. The primary end point was the composite of death, reinfarction, recurrent ischemia, new or worsening heart failure, or cardiogenic shock at 30 days. In this post hoc subgroup analysis, we examined the effect of an early invasive strategy on efficacy and safety outcomes after stratification by time from symptom onset to fibrinolysis (<2 or ≥2 hours). Of 1,059 patients in TRANSFER-AMI, 557 (53%) received fibrinolysis <2 hours and 502 (47%) ≥2 hours after symptom onset. Compared to patients who received fibrinolysis within 2 hours of symptoms, patients who received fibrinolysis ≥2 hours after symptom onset had higher Global Registry of Acute Coronary Events risk scores (median 127 vs 122, p = 0.004). The effect of an early invasive strategy did not differ between symptom-to-fibrinolysis time strata for the primary efficacy end point (p-heterogeneity = 0.67), 30-day mortality, the composite of death or reinfarction at 30 days, 6 months, or 1 year, or bleeding (all p-heterogeneity >0.40). In conclusion, the efficacy and safety of an early invasive strategy in patients undergoing fibrinolysis for STEMI do not vary in relation to time (<2 or ≥2 hours) from symptom onset to fibrinolysis.
authors.affiliation: Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada; Department of medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
authors.forename: Juan J
authors.initials: JJ
authors.lastname: Russo
authors.affiliation: Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada; Department of medicine, University of Toronto, Toronto, Ontario, Canada; Canadian Heart Research Centre, Toronto, Ontario, Canada.
authors.forename: Shaun G
authors.initials: SG
authors.lastname: Goodman
authors.affiliation: Department of medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, Southlake Regional Health Centre, Newmarket, Ontario, Canada.
authors.forename: Warren J
authors.initials: WJ
authors.lastname: Cantor
authors.affiliation: Canadian Heart Research Centre, Toronto, Ontario, Canada.
authors.forename: Mary K
authors.initials: MK
authors.lastname: Tan
authors.affiliation: Division of Emergency Services, Schwartz/Reisman Emergency Centre, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Bjug
authors.initials: B
authors.lastname: Borgundvaag
authors.affiliation: Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada; Department of medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Fitchett
authors.affiliation: Department of medicine, University of Toronto, Toronto, Ontario, Canada; Division of Cardiology, University Health Network and Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: Vladimír
authors.initials: V
authors.lastname: Džavík
authors.affiliation: Department of medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Raymond T
authors.initials: RT
authors.lastname: Yan
authors.affiliation: Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada; Department of medicine, University of Toronto, Toronto, Ontario, Canada.
authors.forename: John J
authors.initials: JJ
authors.lastname: Graham
authors.affiliation: Population Health Research Institute, Hamilton General Hospital, Hamilton, Ontario, Canada.
authors.forename: Shamir R
authors.initials: SR
authors.lastname: Mehta
authors.affiliation: Division of Cardiology, Terrence Donnelly Heart Centre, St Michael's Hospital, Toronto, Ontario, Canada; Department of medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: yana@smh.ca.
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Yan
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000592:standards; D017410:Practice Guidelines as Topic; D012042:Registries; D018570:Risk Assessment; D015607:Stents; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D005343:Fibrinolytic Agents