Copyright © 2003 by the European Society of Cardiology.
Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction
Final results of the randomized national multicentre trial—PRAGUE-2
ínsk
elízko
t'ásek
Received July 2, 2002;
accepted July 3, 2002
Correspondence: Petr Widimsk, MD., PhD., FESC., Cardiocenter Vinohardy, robárova 50, 100 34 Prague 10, Czech Republic.
Abstract
Background Primary percutaneous coronary intervention (PCI) is shown to be the most effective reperfusion strategy in acute myocardial infarction. The aim of this multicentre national randomized mortality trial was to test whether the nationwide change in treatment guidelines (transportation of all patients to PCI centres) was warranted.
Methods The PRAGUE-2 study randomized 850 patients with acute ST elevation myocardial infarction presenting within <12 h to the nearest community hospital without a catheter laboratory to either thrombolysis in this hospital (TL group, n=421) or immediate transport for primary percutaneous coronary intervention (PCI group, n=429). The primary end-point was 30-day mortality. Secondary end-points were: death/reinfarction/stroke at 30 days (combined end-point) and 30-day mortality among patients treated within 0–3 h and 3–12 h after symptom onset. Maximum transport distance was 120 km.
Results Five complications (1.2%) occurred during the transport. Randomization–balloon time in the PCI group was 97±27 min, and randomization–needle time in the TL group was 12±10 min. Mortality at 30 days was 10.0% in the TL group compared to 6.8% mortality in the PCI group (P=0.12, intention-to-treat analysis). Mortality of 380 patients who actually underwent PCI was 6.0% vs 10.4% mortality in 424 patients who finally received TL (P<0.05). Among 299 patients randomized >3 h after the onset of symptoms, the mortality of the TL group reached 15.3% compared to 6% in the PCI group (P<0.02). Patients randomized within <3 h of symptom onset (n=551) had no difference in mortality whether treated by TL (7.4%) or transferred to PCI (7.3%). A combined end-point occurred in 15.2% of the TL group vs 8.4% of the PCI group (P<0.003).
Conclusions Long distance transport from a community hospital to a tertiary PCI centre in the acute phase of AMI is safe. This strategy markedly decreases mortality in patients presenting >3 h after symptom onset. For patients presenting within <3 h of symptoms, TL results are similar results to long distance transport for PCI.
Key Words: Acute myocardial infarction • thrombolysis • long distance transport • coronary intervention • coronary angioplasty • stent
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Part 8: Stabilization of the Patient With Acute Coronary Syndromes Circulation, December 13, 2005; 112(24_suppl): IV-89 - IV-110. [Full Text] [PDF]
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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]
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R C Welsh and P W Armstrong It's a matter of time: contemporary pre-hospital management of acute ST elevation myocardial infarction Heart, December 1, 2005; 91(12): 1524 - 1526. [Full Text] [PDF]
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B R Brodie Facilitated percutaneous coronary intervention Heart, December 1, 2005; 91(12): 1527 - 1529. [Full Text] [PDF]
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E J Smith, A Mathur, and M T Rothman Recent advances in primary percutaneous intervention for acute myocardial infarction Heart, December 1, 2005; 91(12): 1533 - 1536. [Full Text] [PDF]
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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]
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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]
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Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]
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R C Welsh, W Chang, P Goldstein, J Adgey, C B Granger, F W A Verheugt, L Wallentin, F Van de Werf, P W Armstrong, and on behalf of the ASSENT-3 PLUS Investigators Time to treatment and the impact of a physician on prehospital management of acute ST elevation myocardial infarction: insights from the ASSENT-3 PLUS trial Heart, November 1, 2005; 91(11): 1400 - 1406. [Abstract] [Full Text] [PDF]
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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]
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G. B. Danzi, L. Mauri, and F. Sozzi Percutaneous coronary intervention and beyond for ST-elevation acute myocardial infarction Eur. Heart J. Suppl., October 1, 2005; 7(suppl_K): K26 - K30. [Abstract] [Full Text] [PDF]
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P G Steg and J-M Juliard Primary percutaneous coronary intervention in acute myocardial infarction: time, time, and time! Heart, August 1, 2005; 91(8): 993 - 994. [Abstract] [Full Text] [PDF]
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R Zahn, A Vogt, U Zeymer, A K Gitt, K Seidl, M Gottwik, M A Weber, W Niederer, B Modl, H-J Engel, et al. In-hospital time to treatment of patients with acute ST elevation myocardial infarction treated with primary angioplasty: determinants and outcome. Results from the registry of percutaneous coronary interventions in acute myocardial infarction of the Arbeitsgemeinschaft Leitender Kardiologischer Krankenhausarzte Heart, August 1, 2005; 91(8): 1041 - 1046. [Abstract] [Full Text] [PDF]
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Y. G. Yap, T. Duong, M. Bland, M. Malik, C. Torp-Pedersen, L. Kober, S. J. Connolly, B. Marchant, and J. Camm Temporal trends on the risk of arrhythmic vs. non-arrhythmic deaths in high-risk patients after myocardial infarction: a combined analysis from multicentre trials Eur. Heart J., July 2, 2005; 26(14): 1385 - 1393. [Abstract] [Full Text] [PDF]
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A-A Fassa, P Urban, D Radovanovic, N Duvoisin, J-M Gaspoz, J-C Stauffer, P Erne, and for the AMIS Plus Investigators Trends in reperfusion therapy of ST segment elevation myocardial infarction in Switzerland: six year results from a nationwide registry Heart, July 1, 2005; 91(7): 882 - 888. [Abstract] [Full Text] [PDF]
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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]
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C. O'Donnell and R. Verbeek Guidelines for STEMI Can. Med. Assoc. J., May 24, 2005; 172(11): 1425 - 1426. [Full Text] [PDF]
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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]
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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]
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