European Heart Journal Advance Access originally published online on May 8, 2009
European Heart Journal 2009 30(13):1598-1606; doi:10.1093/eurheartj/ehp156
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Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up
1 UMR 5558, Univeristé Lyon 1 et Centre d’Investigation Clinique, Hôpital Cardio-Vasculaire et Pneumologique, Hospices Civils de Lyon, 69394 Lyon Cedex 03, France
2 INSERM U-698, Université Paris 7, AP-HP, Hôpital Bichat, Paris, France
3 Hospices Civils de Lyon, Service de Biostatistique, UMR 5558, CHU de Lyon, Lyon, France
4 SAMU 69 – Hospices Civils de Lyon, Lyon, France
5 SAMU 93, Bobigny, France
6 Pôle Cardiovasculaire – Rangueil, Toulouse, France
7 SAMU 63, Centre Hospitalier Universitaire, Clermont Ferrand, France
8 Service de Cardiologie, Centre Hospitalier Universitaire, Grenoble, France
9 Université Lyon I et service de pharmacologie clinique, Hospices Civils de Lyon, Lyon, France
10 UMR 5558, Université Lyon 1 et CIC, Hospices Civils de Lyon, Lyon, France
Received 4 September 2008; revised 18 March 2009; accepted 19 March 2009; online publish-ahead-of-print 8 May 2009.
* Corresponding author. Tel: +33 4 72 35 75 49, Fax: +33 4 72 35 73 41, Email: eric.bonnefoy-cudraz{at}chu-lyon.fr
Aims: The CAPTIM (Comparison of primary Angioplasty and Pre-hospital fibrinolysis In acute Myocardial infarction) study found no evidence that a strategy of primary angioplasty was superior in terms of 30-day outcomes to a strategy of pre-hospital fibrinolysis with transfer to an interventional facility in patients managed early at the acute phase of an acute myocardial infarction. The present analysis was designed to compare both strategies at 5 years.
Methods and results: The CAPTIM study included 840 patients managed in a pre-hospital setting within 6 h of an acute ST-segment elevation myocardial infarction. Patients were randomized to either a primary angioplasty (n = 421) or a pre-hospital fibrinolysis (rt-PA) with immediate transfer to a centre with interventional facilities (n = 419). Long-term follow-up was obtained in blinded fashion from 795 patients (94.6%). Using an intent-to-treat analysis, all-cause mortality at 5 years was 9.7% in the pre-hospital fibrinolysis group when compared with 12.6% in the primary angioplasty group [HR 0.75 (95% CI, 0.50–1.14); P = 0.18]. For patients included within 2 h, 5 year mortality was 5.8% in the pre-hospital fibrinolysis group when compared with 11.1% in the primary angioplasty group [HR 0.50 (95% CI, 0.25–0.97); P = 0.04], whereas it was, respectively, 14.5 and 14.4% in patients included after 2 h [HR 1.02, (95% CI 0.59–1.75), P = 0.92].
Conclusion: The 5-year follow-up is consistent with the 30-day outcomes of the trial, showing similar mortality for primary percutaneous coronary intervention and a policy of pre-hospital lysis followed by transfer to an interventional center. In addition, for patients treated within 2 h of symptom onset, 5-year mortality was lower with pre-hospital lysis.
Key Words: Angioplasty • Acute myocardial infarction • Fibrinolysis • Reperfusion
A complete list of CAPTIM investigators and personnel can be found in the appendix and in Busk et al.5