Clinical InvestigationAcute Ischemic Heart DiseaseThe influence of time from symptom onset and reperfusion strategy on 1-year survival in ST-elevation myocardial infarction: A pooled analysis of an early fibrinolytic strategy versus primary percutaneous coronary intervention from CAPTIM and WEST
Section snippets
Methods
The details and primary results of the CAPTIM and WEST trials have been previously published.8, 10 In brief, the CAPTIM trial randomized eligible patients at the site of initial management to prehospital FL or direct transfer for primary PCI. All patients received an intravenous bolus of 5,000 U heparin and 250 to 500 mg aspirin. Patients assigned to prehospital FL received an intravenous bolus of alteplase followed by an infusion over 90 minutes. Coronary angiography and subsequent
Results
Individual patient data from the CAPTIM, which enrolled 840 patients with STEMI between 1997 and 2000, and WEST trials, which enrolled 328 patients with STEMI between 2003 and 2005, were obtained for the current study (Figure 1). Baseline patient characteristics according to study treatment are presented in Table I for the individual trials as well as the pooled cohort. Overall, the patients enrolled in the CAPTIM and WEST trials were comparable across the trials and between the study
Discussion
Our novel findings not only support the critical relationship between time from symptom onset and 1-year survival after reperfusion, but also provide new evidence about the impact of this relationship on the relative efficacy of the 2 standard modes of therapy. A survival advantage existed for patients treated with FL within 2 hours of symptom onset relative to those treated with primary PCI (P interaction [unadjusted] = .043). When time from symptom onset was explored in a continuous fashion,
Conclusion
Given persisting evidence of failure to meet guideline-suggested times to PCI, especially among patients presenting to non-PCI hospitals, our data provide additional evidence to support the efficacy of an alternative reperfusion strategy, that is, fibrinolytic therapy (in patients without contraindications, coupled with contemporary adjunctive therapy, timely rescue PCI, and subsequent revascularization), especially in those presenting early after symptom onset either in the prehospital setting
Disclosures
The original WEST study was supported by an unrestricted grant from Hoffmann-LaRoche Limited; Aventis Pharma, a member of the Sanofi-Aventis group; as well as Eli-Lilly Canada. The original CAPTIM study was supported by a grant from the French Ministry of Health (Projet Hospitalier de Recherche Clinique, 96/045), by the Hospices Civils de Lyon, and by an unrestricted research grant from AstraZeneca France. Biotronic GmbH provided balloons and guidewires free of charge.
Drs Armstrong and Welsh
Acknowledgements
The authors would like to acknowledge the expert editorial assistance of Jo-An Padberg.
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2017, International Journal of CardiologyCitation Excerpt :As this factor did not translate into increased mortality, these findings reflect an appropriate clinical decision making to select fibrinolytic therapy when prompt PCI is not feasible. Hence, our results align with the results of clinical trials, suggesting that pre-hospital FT followed by rescue, facilitated or elective angiography in a well-organized system of care is at least equivalent in regards to outcome compared to pPCI [38–42]. 4) The rotational system between the tertiary hospitals offers several advantages: availability of experienced interventionists and other cath-lab personnel on-site (no call-in system as in the majority of international networks) also during “off-hours”, advanced experience of the participating centres following the higher case load, a higher likelihood of critical care unit beds and thus avoidance of early re-transfer to other hospitals.
Temporal Trends of Reperfusion Strategies and Hospital Mortality for Patients With STEMI in Percutaneous Coronary Intervention–Capable Hospitals
2017, Canadian Journal of CardiologyThe Choice Is Reperfusion Therapy: But Which One?
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2016, Canadian Journal of Cardiology
ClinicalTrials.gov Identifier: NCT00121446 (WEST).
- d
For the CAPTIM/WEST Investigators.