Skip Navigation


European Heart Journal Advance Access originally published online on June 6, 2006
European Heart Journal
2006 27(13):1530-1538; doi:10.1093/eurheartj/ehl088
This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow All Versions of this Article:
27/13/1530    most recent
ehl088v1
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Related articles in EHJ
Right arrow Similar articles in this journal
Right arrow Similar articles in ISI Web of Science
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Archive
Right arrow Download to citation manager
Right arrow Search for citing articles in:
ISI Web of Science (33)
Right arrowRequest Permissions
Google Scholar
Right arrow Articles by Armstrong, P. W.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Armstrong, P. W.
Social Bookmarking
 Add to CiteULike   Add to Connotea   Add to Del.icio.us  
What's this?

© The European Society of Cardiology 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention early after ST-elevation myocardial infarction: the WEST (Which Early ST-elevation myocardial infarction Therapy) study

Paul W. Armstrong* and WEST Steering Committee

Canadian VIGOUR Centre, 2-51 Medical Sciences Building, University of Alberta Edmonton, AB, Canada T6G 2H7

Received 11 May 2006; revised 23 May 2006; accepted 24 May 2006; online publish-ahead-of-print 6 June 2006.

* Corresponding author. Tel: +780 492 0591; fax: +780 492 9486. E-mail address: paul.armstrong{at}ualberta.ca

See page 1511 for the editorial comment on this article (doi:10.1093/eurheartj/ehl107)

Aims Uncertainty exists as to which reperfusion strategy for ST-elevation myocardial infarction (MI) is optimal. We evaluated whether optimal pharmacologic therapy at the earliest point of care, emphasizing pre-hospital randomization and treatment was non-inferior to expeditious primary percutaneous coronary intervention (PCI).

Methods and results Which Early ST-elevation myocardial infarction Therapy (WEST) was a four-city Canadian, open-label, randomized, feasibility study of 304 STEMI patients (>4 mm ST-elevation/deviation) within 6 h of symptom onset, emphasizing pre-hospital ambulance treatment and participation of community and tertiary care centres. All received aspirin, subcutaneous enoxaparin (1 mg/kg), and were randomized to one of three groups: (A) tenecteplase (TNK) and usual care, (B) TNK and mandatory invasive study ≤24 h, including rescue PCI for reperfusion failure, and (C) primary PCI with 300 mg loading dose of clopidogrel. Time from symptom onset to treatment was rapid (to TNK for A=113 and B=130 min and for PCI in C=176 min). The primary outcome, a composite of 30-day death, re-infarction, refractory ischaemia, congestive heart failure, cardiogenic shock, and major ventricular arrhythmia, was 25% (Group A), 24% (Group B), and 23% (Group C), respectively. However, there was a higher frequency of the combination of death and recurrent MI in Group A vs. Group C (13.0 vs. 4.0%, respectively, P-logrank=0.021), yet no difference between Group B (6.7%, P-logrank=0.378) and C.

Conclusion These data suggest that a contemporary pharmacologic regimen rapidly delivered, coupled with a strategy of regimented rescue and routine coronary intervention within 24 h of initial treatment, may not be different from timely expert PCI.

Key Words: ST-elevation myocardial infarction • Percutaneous coronary intervention • Fibrinolytic pharmacologic reperfusion


Add to CiteULike CiteULike   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us    What's this?

Related articles in EHJ:

WEST: new data on the integration of early thrombolysis and mechanical intervention in the early management of STEMI
Philippe Gabriel Steg and Nicolas Danchin
EHJ 2006 27: 1511-1512. [Extract] [Full Text]  



This article has been cited by other articles:


Home page
CirculationHome page
G. W. Stone
Angioplasty Strategies in ST-Segment-Elevation Myocardial Infarction: Part I: Primary Percutaneous Coronary Intervention
Circulation, July 29, 2008; 118(5): 538 - 551.
[Full Text] [PDF]


Home page
CirculationHome page
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]


Home page
CirculationHome page
H. D. White
Systems of Care: Need for Hub-and-Spoke Systems for Both Primary and Systematic Percutaneous Coronary Intervention After Fibrinolysis
Circulation, July 15, 2008; 118(3): 219 - 222.
[Full Text] [PDF]


Home page
CirculationHome page
N. Danchin, P. Coste, J. Ferrieres, P.-G. Steg, Y. Cottin, D. Blanchard, L. Belle, B. Ritz, G. Kirkorian, M. Angioi, et al.
Comparison of Thrombolysis Followed by Broad Use of Percutaneous Coronary Intervention With Primary Percutaneous Coronary Intervention for ST-Segment-Elevation Acute Myocardial Infarction: Data From the French Registry on Acute ST-Elevation Myocardial Infarction (FAST-MI)
Circulation, July 15, 2008; 118(3): 268 - 276.
[Abstract] [Full Text] [PDF]


Home page
NEJMHome page
P. Bogaty, J. M. Brophy, S. W. Glickman, K. A. Schulman, C. B. Cairns, J. W. Tam, K. M. Bhagirath, R. K. Philipp, M. R. Le May, G. A. Wells, et al.
Primary PCI in ST-Segment Elevation Myocardial Infarction
N. Engl. J. Med., April 17, 2008; 358(16): 1751 - 1753.
[Full Text] [PDF]


Home page
Eur Heart JHome page
M. C. Tjandrawidjaja, Y. Fu, H. Al-Khalidi, T. G. Todaro, P. Adams, F. Van de Werf, C. B. Granger, P. W. Armstrong, and on behalf of the APEX-AMI Investigators
Failure of investigator adherence to electrocardiographic entry criteria is frequent and influences clinical outcomes: lessons from APEX-AMI
Eur. Heart J., December 1, 2007; 28(23): 2850 - 2857.
[Abstract] [Full Text] [PDF]


Home page
NEJMHome page
B. K. Nallamothu, E. H. Bradley, and H. M. Krumholz
Time to Treatment in Primary Percutaneous Coronary Intervention
N. Engl. J. Med., October 18, 2007; 357(16): 1631 - 1638.
[Full Text] [PDF]


Home page
J Am Coll CardiolHome page
W. E. Boden, K. Eagle, and C. B. Granger
Reperfusion Strategies in Acute ST-Segment Elevation Myocardial Infarction: A Comprehensive Review of Contemporary Management Options
J. Am. Coll. Cardiol., September 4, 2007; 50(10): 917 - 929.
[Abstract] [Full Text] [PDF]


Home page
CirculationHome page
H. H. Ting, C. S. Rihal, B. J. Gersh, L. H. Haro, C. M. Bjerke, R. J. Lennon, C.-C. Lim, J. F. Bresnahan, A. S. Jaffe, D. R. Holmes, et al.
Regional Systems of Care to Optimize Timeliness of Reperfusion Therapy for ST-Elevation Myocardial Infarction: The Mayo Clinic STEMI Protocol
Circulation, August 14, 2007; 116(7): 729 - 736.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
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]


Home page
CMAJHome page
A. Travers
Achieving optimal care for ST-segment elevation myocardial infarction in Canada
Can. Med. Assoc. J., June 19, 2007; 176(13): 1843 - 1844.
[Full Text] [PDF]


Home page
Eur Heart JHome page
F. Fernandez-Aviles, J. J. Alonso, G. Pena, J. Blanco, J. Alonso-Briales, J. Lopez-Mesa, F. Fernandez-Vazquez, J. Moreu, R. A. Hernandez, A. Castro-Beiras, et al.
Primary angioplasty vs. early routine post-fibrinolysis angioplasty for acute myocardial infarction with ST-segment elevation: the GRACIA-2 non-inferiority, randomized, controlled trial
Eur. Heart J., April 2, 2007; 28(8): 949 - 960.
[Abstract] [Full Text] [PDF]


Home page
Eur Heart JHome page
T. Siminiak and D. Dudek
Fibrinolysis may widen the time window for primary angioplasty
Eur. Heart J., April 2, 2007; 28(8): 915 - 917.
[Full Text] [PDF]


Home page
JAMAHome page
C. S. Rihal, A. S. Jaffe, D. R. Holmes Jr, H. H. Ting, B. J. Gersh, and M. R. Bell
Percutaneous Coronary Intervention vs Thrombolysis for ST-Elevation Myocardial Infarction
JAMA, March 28, 2007; 297(12): 1313 - 1313.
[Full Text] [PDF]


Home page
Journal Watch CardiologyHome page
Integrated Fibrinolysis Approach vs. Primary PCI in STEMI
Journal Watch Cardiology, August 23, 2006; 2006(823): 2 - 2.
[Full Text]


Home page
Eur Heart JHome page
P. G. Steg and N. Danchin
WEST: new data on the integration of early thrombolysis and mechanical intervention in the early management of STEMI
Eur. Heart J., July 1, 2006; 27(13): 1511 - 1512.
[Full Text] [PDF]



Disclaimer:
Please note that abstracts for content published before 1996 were created through digital scanning and may therefore not exactly replicate the text of the original print issues. All efforts have been made to ensure accuracy, but the Publisher will not be held responsible for any remaining inaccuracies. If you require any further clarification, please contact our Customer Services Department.