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European Heart Journal 2001 22(22):2104-2115; doi:10.1053/euhj.2001.2622
Copyright © 2001 by the European Society of Cardiology.
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Availability of on-site catheterization and clinical outcomes in patients receiving fibrinolysis for ST-elevation myocardial infarction

J Llevadota,f1, R.P Giuglianoa,f1,f2, E.M Antmana, R.G Wilcoxb, E.P Gurfinkelc, T Henryd, C.H McCabea, A Charlesworthe, S Thompsone, J.C Nicolauf, U Tebbeg, Z Sadowskih and E Braunwald for the InTIME (intraenous nPA for Treatment of Infarcting Myocardium Early) II Invatigatorsa InTIME (intraenous nPA for Treatment of Infarcting Myocardium Early) II Invatigators

a TIMI Study Group, Cardiovascular Division, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, U.S.A.
b Division of Cardiovascular Medicine, Queen's Medical Centre, Nottingham, U.K.
c Fundacion Favaloro, Buenos Aires, Argentina
d Hennepin County Medical Center, Minneapolis, MN, U.S.A.
e Nottingham Clinical Research Group, Nottingham, U.K.
f Instituto de Coracao, Sao Paolo, Brasil
g Klinikum Lippe-Detmold, Detmold, Germany
h Klinika Choroby Wiencowej, Warsaw, Poland

revised January 23, 2001; accepted January 24, 2001

Abstract

Aims To compare management and clinical outcomes in hospitals stratified by the availability of on-site catheterization in InTIME-II, a multicentre trial comparing alteplase with lanoteplase for acute myocardial infarction.

Methods and Results We studied 15–078 patients enrolled in 35 countries and 855 hospitals. Thirty-one percent of hospitals had 24-h, 25% day-only, and 44% no on-site catheterization facilities. Rates of cardiac angiography (57%, 38%, 26%) and revascularization (37%, 21%, 17%) were higher in hospitals with increasing access to on-site facilities )

Conclusions There is a marked variation in procedure use by the availability of on-site catheterization with no major differences in patient outcomes. There is a need for additional randomized trials in the current era to address both the appropriate selection of patients and timing of invasive procedures in ST-elevation acute myocardial infarction.

Key Words: Myocardial infarction, fibrinolysis, availability of on-site catheterization, outcomes

f1 These authors contributed equally to the manuscript.

f2 Correspondence: Robert P. Giugliano MD, SM, TIMI Study Office, 333 Longwood Avenue, Suite 402, Boston, MA 02115, U.S.A.


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