European Heart Journal Advance Access originally published online on September 20, 2007
European Heart Journal 2007 28(20):2438-2448; doi:10.1093/eurheartj/ehm369
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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
aw Prokopczuk1
1 Department of Invasive Cardiology, State Teaching Hospital, Medical University of Bialystok, Sklodowskiej 24a, 15-276 Bialystok, Poland
2 Department of Cardiology, State Teaching Hospital, Medical University of Bialystok, Poland
3 Department of Statistics and Medical Informatics, Medical University of Bialystok, Poland
Received 27 November 2006; revised 25 July 2007; accepted 3 August 2007; online publish-ahead-of-print 20 September 2007.
* Corresponding author. Tel: +48 857468496; fax +48 85 7468828. E-mail address: paqral{at}yahoo.com
Aims: Our study aimed to compare two reperfusion strategies in patients with ST-elevation myocardial infarction (STEMI) admitted initially to a community hospital without catheterization facilities.
Methods and results: Four hundred and one patients with STEMI admitted to community hospital (13 hospitals, radius 20–150 km from cath-lab) were randomized to on-site thrombolysis or to transport with tirofiban (10 µg/kg bolus i.v. + i.v. infusion 0.1 µg/kg/min) for primary PCI in single invasive centre. Primary endpoints were total mortality, recurrent MI (re-AMI), and stroke during 1 year follow-up. Delay to reperfusion defined as interval between admission and start of fibrinolysis or primary PCI was 35 and 145 min (P < 0.0001). Mean time of tirofiban administration to PCI in transfer group was: 122.3 ± 35.7 min. Mortality was not different during hospitalization and at 30th-day, with trend towards lower mortality at 1 year in transport group (12.5 vs. 7.0%, P = 0.061). There were no differences in the rate of re-AMI and stroke, with trend towards lower incidence of re-AMI in transfer group at 1 year (7.5 vs. 3.5%, P = 0.073). Composite of death/re-AMI/stroke was higher in on-site group during follow-up (15.5 vs. 8.0%, P = 0.019; 21.5 vs. 11.4%, P = 0.006, respectively, at 30th-day and 1 year).
Conclusion: Outcomes at 1 year follow-up suggest that transportation with adjunctive therapy with GP IIb/IIIa inhibitor tirofiban for primary PCI is superior to on-site thrombolysis for patient with STEMI presenting to hospital without catheterization facilities.
Key Words: ST-elevation myocardial infarction • Primary PCI • Thrombolysis • Transfer • Platelet GP IIb/IIIa • Tirofiban