title: Early ST elevation myocardial infarction in non-capable percutaneous coronary intervention centres: in situ fibrinolysis vs. percutaneous coronary intervention transfer.
abstract: OBJECTIVE
  The preferred reperfusion strategy for early ST elevation myocardial infarction (STEMI, defined as time from symptoms onset ≤120 min) in non-capable percutaneous coronary intervention (PCI) centres remains controversial. We sought to compare mortality of in situ fibrinolysis vs. PCI transfer in a real-life consecutive cohort of early STEMI.
  
  
  RESULTS
  Prospective multicentre STEMI registry (Catalonia 'Codi IAM' network) of all-comers in a non-capable PCI centre with symptom onset to first medical contact (FMC) <120 min. Two groups were identified: in situ fibrinolysis and transfer to a PCI-capable centre. Primary endpoint was 30-day mortality. We included 2470 patients, of whom 2227 (90.2%) and 243 (9.8%) comprised the transfer and fibrinolysis groups, respectively. In the fibrinolysis group, diagnostic and system delays were shorter (24 vs. 31 min, P < 0.001; 45 vs. 119 min, P < 0.001, respectively). Thirty-day mortality was 7.7 and 5.1% in fibrinolysis and transfer groups, respectively (P = 0.09). However, patients in the transfer group whose time FMC-device was achieved within 140 min were associated with significantly lower mortality (2.0% for FMC-device <99 min, and 4.6% for FMC-device 99-140 min; P < 0.01 and P = 0.03, respectively vs. fibrinolysis). In multivariable logistic regression analysis, reperfusion with fibrinolysis was an independent 30-day mortality predictive factor (odds ratio: 1.91, 95% confidence interval: 1.01-3.50; P = 0.04), together with age and Killip-Kimball class (both P < 0.001).
  
  
  CONCLUSIONS
  In early STEMI patients assisted in non-capable PCI centres, in situ fibrinolysis had worse prognosis than patient transfer. Transfer to a PCI-capable centre seems recommended in patients with FMC-device delay <140 min.
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain xcarrillo.germanstrias@gencat.cat xcarrillosuarez@gmail.com.
authors.forename: Xavier
authors.initials: X
authors.lastname: Carrillo
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain.
authors.forename: Eduard
authors.initials: E
authors.lastname: Fernandez-Nofrerias
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain.
authors.forename: Oriol
authors.initials: O
authors.lastname: Rodriguez-Leor
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain.
authors.forename: Teresa
authors.initials: T
authors.lastname: Oliveras
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Serra
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain Health Department, Generalitat de Catalunya, Catalonia, Spain.
authors.forename: Josepa
authors.initials: J
authors.lastname: Mauri
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain Health Department, Generalitat de Catalunya, Catalonia, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Curos
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Rueda
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain.
authors.forename: Cosme
authors.initials: C
authors.lastname: García-García
authors.affiliation: Health Department, Generalitat de Catalunya, Catalonia, Spain.
authors.forename: Ricard
authors.initials: R
authors.lastname: Tresserras
authors.affiliation: Health Department, Generalitat de Catalunya, Catalonia, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Rosas
authors.affiliation: Health Department, Generalitat de Catalunya, Catalonia, Spain.
authors.forename: Maria Teresa
authors.initials: MT
authors.lastname: Faixedas
authors.affiliation: Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Bayes-Genis
mesh_terms: D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer; D062645:Percutaneous Coronary Intervention / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D012189:Retrospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D013030:Spain / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000379:methods* / Q000401:mortality; D061665:Time-to-Treatment
keywords: Codi IAM; Fibrinolysis; Primary angioplasty; STEMI; STEMI network