title: Comparison of 30-day mortality and myocardial scar indices for patients treated with prehospital reduced dose fibrinolytic followed by percutaneous coronary intervention versus percutaneous coronary intervention alone for treatment of ST-elevation myocardial infarction.
abstract: OBJECTIVE
  We investigated whether prehospital, reduced dose fibrinolysis coupled with urgent percutaneous coronary intervention (FAST-PCI) reduces mortality and cardiac magnetic resonance (CMR) measures of infarct size, compared with primary percutaneous coronary intervention (PPCI), in patients with ST-elevation myocardial infarction (STEMI).
  
  
  BACKGROUND
  Current standard therapy for STEMI is PPCI. However, FAST-PCI may shorten ischemic time (IT) and improve outcomes.
  
  
  METHODS
  Eligible STEMI patients received prehospital, reduced dose fibrinolysis along with standard therapy, and were transported for urgent percutaneous coronary intervention, or else they received usual treatment without prehospital fibrinolysis. Patients were divided retrospectively into four groups based on IT (<120, 120-179, 180-239 min, ≥240) for a mortality analysis cohort, and into three groups (<120, 120-179, ≥180 min) for a CMR analysis cohort. Within each IT group, patients were compared by FAST-PCI vs. PPCI strategy.
  
  
  RESULTS
  Between 1/2007 and 2/2014, 1,112 STEMI patients were treated. FAST-PCI was employed in 551 and PPCI in 561. Of these, 357 (32.1%) underwent CMR. The treatment groups were well matched. In STEMI patients with short IT (<120 and 120-179 min groups), those treated by FAST-PCI had lower 30-day mortality and myocardial scar sizes compared with PPCI treatment. For IT ≥180 min, the mortalities and myocardial scar sizes were equivalent for both groups.
  
  
  CONCLUSIONS
  In STEMI patients with IT <180 min, FAST-PCI may reduce 30-day mortality and myocardial scar size compared with PPCI. This suggests that infarct interventions must be instituted within 3 hr of symptom onset in order to detect an optimal beneficial effect both clinically and by CMR measurement. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Amirreza
authors.initials: A
authors.lastname: Solhpour
authors.affiliation: Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Kay-Won
authors.initials: KW
authors.lastname: Chang
authors.affiliation: Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Salman A
authors.initials: SA
authors.lastname: Arain
authors.affiliation: Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Prakash
authors.initials: P
authors.lastname: Balan
authors.affiliation: Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Yelin
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Catalin
authors.initials: C
authors.lastname: Loghin
authors.affiliation: Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: James J
authors.initials: JJ
authors.lastname: McCarthy
authors.affiliation: Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: H
authors.initials: H
authors.lastname: Vernon Anderson
authors.affiliation: Cardiology Department, University of Texas Health Science Center and Memorial Hermann Heart and Vascular Institute, Houston, Texas.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Smalling
mesh_terms: D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D005500:Follow-Up Studies; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011446:Prospective Studies; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D015996:Survival Rate / Q000639:trends; D013781:Texas / Q000453:epidemiology; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors
chemical_list: D005343:Fibrinolytic Agents
keywords: fibrinolytic; magnetic resonance imaging; myocardial infarction; myocardial scar