Copyright © 2000 by the European Society of Cardiology.
Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE Study
a,f1
a
a Cardiocenter, University Hospital, Vinohrady, Prague, Czech Republic
b Hospital De Weezenlanden, Zwolle, The Netherlands
revised October 4, 1999; accepted October 6, 1999
Abstract
Background Primary coronary angioplasty is an effective reperfusion strategy in acute myocardial infarction. However, its availability is limited, and transporting patients to an angioplasty centre in the acute phase of myocardial infarction has not yet been proved safe.
Methods The PRAGUE study (PRimary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency thrombolysis) compared three reperfusion strategies in patients with acute myocardial infarction, presenting within 6h of symptom onset at community hospitals without a catheterization laboratory: group A—thrombolytic therapy in community hospitals (n=99), group B—thrombolytic therapy during transportation to angioplasty (n=100), group C—immediate transportation for primary angioplasty without pre-treatment with thrombolysis (n=101).
Results No complications occurred during transportation in group C. Two ventricular fibrillations occurred during transportation in group B. Median admission–reperfusion time in transported patients (group B 106min, group C 96min) compared favourably with the anticipated >90min in group A. The combined primary end-point (death/reinfarction/stroke at 30 days) was less frequent in group C (8%) compared to groups B (15%) and A (23%, P<0·02). The incidence of reinfarction was markedly reduced by transport to primary angioplasty (1% in group C vs 7% in group B vs 10% in group A,P <0·03).
Conclusions Transferring patients from community hospitals to a tertiary angioplasty centre in the acute phase of myocardial infarction is feasible and safe. This strategy is associated with a significant reduction in the incidence of reinfarction and the combined clinical end-point of death/reinfarction/stroke at 30 days when compared to standard thrombolytic therapy at the community hospital.
Key Words: acute myocardial infarction, reperfusion, thrombolysis, transport, primary coronary angioplasty
f1 Correspondence: Petr Widimský, MD, PhD, FESC, Cardiocenter Vinohrady, 
robárova 50, 100 34 Prague 10, Czech Republic.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  G. W. Stone Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part II: Intervention After Fibrinolytic Therapy, Integrated Treatment Recommendations, and Future Directions Circulation, July 29, 2008; 118(5): 552 - 566. [Full Text] [PDF]
|
|
|
|
 |
|
 S. G. Goodman, V. Menon, C. P. Cannon, G. Steg, E. M. Ohman, and R. A. Harrington Acute ST-Segment Elevation Myocardial Infarction: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 708S - 775S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Busk, M. Maeng, K. Rasmussen, H. Kelbaek, P. Thayssen, U. Abildgaard, E. Vigholt, L. S. Mortensen, L. Thuesen, S. D. Kristensen, et al. The Danish multicentre randomized study of fibrinolytic therapy vs. primary angioplasty in acute myocardial infarction (the DANAMI-2 trial): outcome after 3 years follow-up Eur. Heart J., May 2, 2008; 29(10): 1259 - 1266. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Z Motovska, P Widimsky, M Aschermann, and on behalf of The PRAGUE Study Group Investigators The impact of gender on outcomes of patients with ST elevation myocardial infarction transported for percutaneous coronary intervention: analysis of the PRAGUE-1 and 2 studies Heart, March 1, 2008; 94(3): e5 - e5. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A T Ratcliffe and C Pepper Thrombolysis or primary angioplasty? Reperfusion therapy for myocardial infarction in the UK Postgrad. Med. J., February 1, 2008; 84(988): 73 - 77. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. R. Le May, D. Y. So, R. Dionne, C. A. Glover, M. P.V. Froeschl, G. A. Wells, R. F. Davies, H. L. Sherrard, J. Maloney, J.-F. Marquis, et al. A Citywide Protocol for Primary PCI in ST-Segment Elevation Myocardial Infarction N. Engl. J. Med., January 17, 2008; 358(3): 231 - 240. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 American College of Cardiology/American Heart Asso, Developed in Collaboration With the Canadian Cardi, Endorsed by the American Academy of Family Physici, 2007 Writing Group to Review New Evidence and Upda, E. M. Antman, M. Hand, P. W. Armstrong, E. R. Bates, L. A. Green, L. K. Halasyamani, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction J. Am. Coll. Cardiol., January 15, 2008; 51(2): 210 - 247. [Full Text] [PDF]
|
|
|
|
|
|
American College of Cardiology/American Heart Asso, 2007 Writing Group to Review New Evidence and Upda, S. B. King III, S. C. Smith Jr, J. W. Hirshfeld Jr, A. K. Jacobs, D. A. Morrison, and D. O. Williams 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention J. Am. Coll. Cardiol., January 15, 2008; 51(2): 172 - 209. [Full Text] [PDF]
|
|
|
|
|
|
E. M. Antman, M. Hand, P. W. Armstrong, E. R. Bates, L. A. Green, L. K. Halasyamani, J. S. Hochman, H. M. Krumholz, G. A. Lamas, C. J. Mullany, et al. 2007 Focused Update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: Developed in Collaboration With the Canadian Cardiovascular Society Endorsed by the American Academy of Family Physicians: 2007 Writing Group to Review New Evidence and Update the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction, Writing on Behalf of the 2004 Writing Committee Circulation, January 15, 2008; 117(2): 296 - 329. [Full Text] [PDF]
|
|
|
|
|
|
S. B. King III, S. C. Smith Jr, J. W. Hirshfeld Jr, A. K. Jacobs, D. A. Morrison, D. O. Williams, 2005 WRITING COMMITTEE MEMBERS, S. C. Smith Jr, T. E. Feldman, J. W. Hirshfeld Jr, et al. 2007 Focused Update of the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines: 2007 Writing Group to Review New Evidence and Update the ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention, Writing on Behalf of the 2005 Writing Committee Circulation, January 15, 2008; 117(2): 261 - 295. [Full Text] [PDF]
|
|
|
|
|
|
S. Dobrzycki, P. Kralisz, K. Nowak, P. Prokopczuk, W. Kochman, J. Korecki, B. Poniatowski, J. Zuk, E. Sitniewska, H. Bachorzewska-Gajewska, et al. Transfer with GP IIb/IIIa inhibitor tirofiban for primary percutaneous coronary intervention vs. on-site thrombolysis in patients with ST-elevation myocardial infarction (STEMI): a randomized open-label study for patients admitted to community hospitals Eur. Heart J., October 2, 2007; 28(20): 2438 - 2448. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Carstensen, G. C.I. Nelson, P. S. Hansen, L. Macken, S. Irons, M. Flynn, P. Kovoor, S. Y. Soo Hoo, M. R. Ward, and H. H. Rasmussen Field triage to primary angioplasty combined with emergency department bypass reduces treatment delays and is associated with improved outcome Eur. Heart J., October 1, 2007; 28(19): 2313 - 2319. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Asseburg, Y. Bravo Vergel, S. Palmer, E. Fenwick, M. de Belder, K. R Abrams, and M. Sculpher Assessing the effectiveness of primary angioplasty compared with thrombolysis and its relationship to time delay: a Bayesian evidence synthesis Heart, October 1, 2007; 93(10): 1244 - 1250. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. D. Henry, S. W. Sharkey, M. N. Burke, I. J. Chavez, K. J. Graham, C. R. Henry, D. L. Lips, J. D. Madison, K. M. Menssen, M. R. Mooney, et al. A Regional System to Provide Timely Access to Percutaneous Coronary Intervention for ST-Elevation Myocardial Infarction Circulation, August 14, 2007; 116(7): 721 - 728. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. P. Faxon Development of Systems of Care for ST-Elevation Myocardial Infarction Patients: Current State of ST-Elevation Myocardial Infarction Care Circulation, July 10, 2007; 116(2): e29 - e32. [Full Text] [PDF]
|
|
|
|
|
|
C. B. Granger, T. D. Henry, W. E. R. Bates, B. Cercek, W. D. Weaver, and D. O. Williams Development of Systems of Care for ST-Elevation Myocardial Infarction Patients: The Primary Percutaneous Coronary Intervention (ST-Elevation Myocardial Infarction Receiving) Hospital Perspective Circulation, July 10, 2007; 116(2): e55 - e59. [Full Text] [PDF]
|
|
|
|
 |
|
 J. R. Timmer, J. P. Ottervanger, M.-J. de Boer, E. Boersma, C. L. Grines, C. M. Westerhout, R. J. Simes, C. B. Granger, F. Zijlstra, and for the Primary Coronary Angioplasty vs Thrombolys Primary Percutaneous Coronary Intervention Compared With Fibrinolysis for Myocardial Infarction in Diabetes Mellitus: Results From the Primary Coronary Angioplasty vs Thrombolysis-2 Trial Arch Intern Med, July 9, 2007; 167(13): 1353 - 1359. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Kiernan, H. H. Ting, and B. J. Gersh Facilitated percutaneous coronary intervention: current concepts, promises, and pitfalls Eur. Heart J., July 1, 2007; 28(13): 1545 - 1553. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. S. de Villiers, T. Anderson, J. D. McMeekin, R. C.M. Leung, M. Traboulsi, and for the Foothills Interventional Cardiology Servic Expedited transfer for primary percutaneous coronary intervention: a program evaluation Can. Med. Assoc. J., June 19, 2007; 176(13): 1833 - 1838. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Eeckhout RESCUE PERCUTANEOUS CORONARY INTERVENTION: DOES THE CONCEPT MAKE SENSE? Heart, May 1, 2007; 93(5): 632 - 638. [Full Text] [PDF]
|
|
|
|
 |
|
 C. S. Hollenbeak, J. P. Fitzgibbons, M. Rossi, D. L. Morris, and P. Stillman The Impact of Percutaneous Coronary Interventions on Outcomes for Acute Myocardial Infarction in Pennsylvania American Journal of Medical Quality, March 1, 2007; 22(2): 85 - 94. [Abstract] [PDF]
|
|
|
|
|
|
H. C. Wijeysundera, R. Vijayaraghavan, B. K. Nallamothu, J. M. Foody, H. M. Krumholz, C. O. Phillips, A. Kashani, J. J. You, J. V. Tu, and D. T. Ko Rescue Angioplasty or Repeat Fibrinolysis After Failed Fibrinolytic Therapy for ST-Segment Myocardial Infarction: A Meta-Analysis of Randomized Trials J. Am. Coll. Cardiol., January 30, 2007; 49(4): 422 - 430. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M Sejersten, Y Birnbaum, R S Ripa, C Maynard, G S Wagner, P Clemmensen, and for the DANAMI-2 Investigators Influences of electrocardiographic ischaemia grades and symptom duration on outcomes in patients with acute myocardial infarction treated with thrombolysis versus primary percutaneous coronary intervention: results from the DANAMI-2 trial Heart, November 1, 2006; 92(11): 1577 - 1582. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. H. Ting, E. H. Yang, and C. S. Rihal Narrative review: reperfusion strategies for ST-segment elevation myocardial infarction. Ann Intern Med, October 17, 2006; 145(8): 610 - 617. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-P. Collet, G. Montalescot, M. Le May, M. Borentain, and A. Gershlick Percutaneous Coronary Intervention After Fibrinolysis: A Multiple Meta-Analyses Approach According to the Type of Strategy J. Am. Coll. Cardiol., October 3, 2006; 48(7): 1326 - 1335. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. B. Borden and D. P. Faxon Facilitated Percutaneous Coronary Intervention J. Am. Coll. Cardiol., September 19, 2006; 48(6): 1120 - 1128. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. S. Rathore, A. J. Epstein, B. K. Nallamothu, and H. M. Krumholz Regionalization of ST-Segment Elevation Acute Coronary Syndromes Care: Putting a National Policy in Proper Perspective J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1346 - 1349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. D. Henry, J. M. Atkins, M. S. Cunningham, G. S. Francis, W. J. Groh, R. A. Hong, K. B. Kern, D. M. Larson, E. M. Ohman, J. P. Ornato, et al. ST-Segment Elevation Myocardial Infarction: Recommendations on Triage of Patients to Heart Attack Centers: Is it Time for a National Policy for the Treatment of ST-Segment Elevation Myocardial Infarction? J. Am. Coll. Cardiol., April 4, 2006; 47(7): 1339 - 1345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. Boersma and The Primary Coronary Angioplasty vs. Thrombolysis Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients Eur. Heart J., April 1, 2006; 27(7): 779 - 788. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J P S Henriques, F Zijlstra, A W J van 't Hof, M-J de Boer, J-H E Dambrink, A T M Gosselink, J C A Hoorntje, J P Ottervanger, and H Suryapranata Primary percutaneous coronary intervention versus thrombolytic treatment: long term follow up according to infarct location Heart, January 1, 2006; 92(1): 75 - 79. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Part 8: Stabilization of the Patient With Acute Coronary Syndromes Circulation, December 13, 2005; 112(24_suppl): IV-89 - IV-110. [Full Text] [PDF]
|
|
|
|
|
|
W. J. Cantor, F. Brunet, C. P. Ziegler, A. Kiss, and L. J. Morrison Immediate angioplasty after thrombolysis: a systematic review Can. Med. Assoc. J., December 6, 2005; 173(12): 1473 - 1481. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J.-P. Bassand, N. Danchin, G. Filippatos, A. Gitt, C. Hamm, S. Silber, M. Tubaro, and F. Weidinger Implementation of reperfusion therapy in acute myocardial infarction. A policy statement from the European Society of Cardiology Eur. Heart J., December 2, 2005; 26(24): 2733 - 2741. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B R Brodie Facilitated percutaneous coronary intervention Heart, December 1, 2005; 91(12): 1527 - 1529. [Full Text] [PDF]
|
|
|
|
|
|
A de Belder Should primary angioplasty be available for all patients with an ST elevation myocardial infarction? Heart, December 1, 2005; 91(12): 1509 - 1511. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K D Dawkins, T Gershlick, M de Belder, A Chauhan, G Venn, P Schofield, D Smith, J Watkins, H H Gray, and Joint Working Group on Percutaneous Coronary Inter Percutaneous coronary intervention: recommendations for good practice and training Heart, December 1, 2005; 91(suppl_6): vi1 - vi27. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]
|
|
|
|
|
|
Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]
|
|
|
|
|
|
K. Huber, R. D. Caterina, S. D. Kristensen, F. W.A. Verheugt, G. Montalescot, L. B. Maestro, F. V. d. Werf, and for the Task Force on Pre-hospital Reperfusion The Pre-hospital reperfusion therapy: a strategy to improve therapeutic outcome in patients with ST-elevation myocardial infarction Eur. Heart J., October 1, 2005; 26(19): 2063 - 2074. [Full Text] [PDF]
|
|
|
|
|
|
A G C Sutton, P G Campbell, R Graham, D J A Price, J C Gray, E D Grech, J A Hall, A A Harcombe, R A Wright, R H Smith, et al. One year results of the Middlesbrough early revascularisation to limit infarction (MERLIN) trial Heart, October 1, 2005; 91(10): 1330 - 1337. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Beygui and G. Montalescot The use of GP IIb/IIIa inhibitors into new perspectives: pre-catheterization laboratory administration Eur. Heart J. Suppl., October 1, 2005; 7(suppl_I): I10 - I14. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Le May, G. A. Wells, M. Labinaz, R. F. Davies, M. Turek, D. Leddy, J. Maloney, T. McKibbin, B. Quinn, R. S. Beanlands, et al. Combined Angioplasty and Pharmacological Intervention Versus Thrombolysis Alone in Acute Myocardial Infarction (CAPITAL AMI Study) J. Am. Coll. Cardiol., August 2, 2005; 46(3): 417 - 424. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Reperfusion in acute myocardial infarction DTB, July 1, 2005; 43(7): 49 - 53. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P M Schofield Acute myocardial infarction: the case for pre-hospital thrombolysis with or without percutaneous coronary intervention Heart, June 1, 2005; 91(suppl_3): iii7 - iii11. [Full Text] [PDF]
|
|
|
|
|
|
H R Andersen, C J Terkelsen, L Thuesen, L R Krusell, S D Kristensen, H E Botker, J F Lassen, and T T Nielsen Myocardial infarction centres: the way forward Heart, June 1, 2005; 91(suppl_3): iii12 - iii15. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. O'Donnell and R. Verbeek Guidelines for STEMI Can. Med. Assoc. J., May 24, 2005; 172(11): 1425 - 1426. [Full Text] [PDF]
|
|
|
|
|
|
C. J. Terkelsen, J. F. Lassen, B. L. Norgaard, J. C. Gerdes, S. H. Poulsen, K. Bendix, J. P. Ankersen, L. B.-H. Gotzsche, F. K. Romer, T. T. Nielsen, et al. Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-hospital diagnosis and direct referral to primary percutanous coronary intervention Eur. Heart J., April 2, 2005; 26(8): 770 - 777. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al. Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Eur. Heart J., April 2, 2005; 26(8): 804 - 847. [Full Text] [PDF]
|
|
|
|
 |
|
 S. S. Rathore, A. J. Epstein, K. G. M. Volpp, and H. M. Krumholz Regionalization of Care for Acute Coronary Syndromes: More Evidence Is Needed JAMA, March 16, 2005; 293(11): 1383 - 1387. [Full Text] [PDF]
|
|
|
|
|
|
B. J. Gersh, G. W. Stone, H. D. White, and D. R. Holmes Jr Pharmacological Facilitation of Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction: Is the Slope of the Curve the Shape of the Future? JAMA, February 23, 2005; 293(8): 979 - 986. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. C. Herrmann Transfer for Primary Angioplasty: The Importance of Time Circulation, February 15, 2005; 111(6): 718 - 720. [Full Text] [PDF]
|
|
|
|
|
|
B. K. Nallamothu, E. R. Bates, J. Herrin, Y. Wang, E. H. Bradley, H. M. Krumholz, and for the NRMI Investigators Times to Treatment in Transfer Patients Undergoing Primary Percutaneous Coronary Intervention in the United States: National Registry of Myocardial Infarction (NRMI)-3/4 Analysis Circulation, February 15, 2005; 111(6): 761 - 767. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S D Kristensen, H R Andersen, L Thuesen, L R Krusell, H E Botker, J F Lassen, and T T Nielsen Should patients with acute ST elevation MI be transferred for primary PCI? Heart, November 1, 2004; 90(11): 1358 - 1363. [Full Text] [PDF]
|
|
|
|
|
|
J. M. Brophy and P. Bogaty Primary Angioplasty and Thrombolysis Are Both Reasonable Options in Acute Myocardial Infarction Ann Intern Med, August 17, 2004; 141(4): 292 - 297. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
E. C. Keeley and C. L. Grines Primary Percutaneous Coronary Intervention for Every Patient with ST-Segment Elevation Myocardial Infarction: What Stands in the Way? Ann Intern Med, August 17, 2004; 141(4): 298 - 304. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
|