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European Heart Journal Advance Access originally published online on February 13, 2007
European Heart Journal 2007 28(6):679-684; doi:10.1093/eurheartj/ehl535
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Long-term outcomes of patients with acute myocardial infarction presenting to hospitals without catheterization laboratory and randomized to immediate thrombolysis or interhospital transport for primary percutaneous coronary intervention. Five years' follow-up of the PRAGUE-2 trial

Petr Widimsky1,*, Dana Bilkova1, Martin Penicka1, Martin Novak2, Miroslava Lanikova1, Vladimir Porizka3, Ladislav Groch2, Michael Zelizko3, Tomas Budesinsky1, Michael Aschermann on behalf of the PRAGUE Study Group Investigators1

1 Cardiocenter Vinohrady, Third Faculty of Medicine, Charles University, Srobarova 50, 100 34 Prague 10, Czech Republic
2 Masaryk University, Brno, Czech Republic
3 IKEM, Prague, Czech Republic,{dagger}

Received 7 August 2006; revised 10 January 2007; accepted 18 January 2007; online publish-ahead-of-print 13 February 2007.

* Corresponding author. Tel/fax: +420 267 163 159. E-mail address: widim{at}fnkv.cz

See page 655 for the editorial comment on this article (doi:10.1093/eurheartj/ehl577)

Aim Randomized trials in ST-elevation myocardial infarction (STEMI) showed improved early outcomes after primary percutaneous coronary intervention (p-PCI) compared with thrombolysis (TL). It is less known whether the early benefit is sustained during the long-term follow-up.

Methods and results The PRAGUE-2 trial enrolled 850 STEMI patients presenting to community hospitals without cath-labs within 12 h of symptom onset. Patients were randomized into the groups ‘TL in community hospital’ (n = 421) and ‘interhospital transfer for p-PCI’ (n = 429).

Follow-up data were available in 416 (98.8%) patients in the TL group and 428 (99.8%) in the p-PCI group. At 5 year follow-up, the cumulative incidence of composite endpoint (death from any cause or recurrent infarction or stroke or revascularization) was 53% in TL patients compared with 40% in p-PCI patients (HR 1.8; 95% CI 1.38–2.33; P < 0.001). The respective cumulative incidence of death from any cause was 23 and 19% (HR 1.34; 95% CI 0.99–1.82; P = 0.06), recurrent infarction 19 vs. 12% (HR 1.72; 95% CI 1.15–2.58; P = 0.009), stroke 8 vs. 8% (HR 1.65; 95% CI 0.84–2.23; P = 0.18), revascularization 51 vs. 34% (HR 1.81; 95% CI 1.21–2.35; P < 0.001).

Conclusion The early benefit from the p-PCI strategy (over TL) is sustained during the 5 years' follow-up. It can be almost exclusively derived from differences in event rate during the first month.

Key Words: Myocardial infarction • Primary coronary intervention • Thrombolysis • Interhospital transport • Long-term outcome

{dagger} Along with IKEM Prague , 51 hospitals in the Czech Republic participated in the trial.


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