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Previous Volume 349:733-742 August 21, 2003 Number 8 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Jacobs, A. K. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background For the treatment of myocardial infarction with ST-segment elevation, primary angioplasty is considered superior to fibrinolysis for patients who are admitted to hospitals with angioplasty facilities. Whether this benefit is maintained for patients who require transportation from a community hospital to a center where invasive treatment is available is uncertain.

Methods We randomly assigned 1572 patients with acute myocardial infarction to treatment with angioplasty or accelerated treatment with intravenous alteplase; 1129 patients were enrolled at 24 referral hospitals and 443 patients at 5 invasive-treatment centers. The primary study end point was a composite of death, clinical evidence of reinfarction, or disabling stroke at 30 days.

Results Among patients who underwent randomization at referral hospitals, the primary end point was reached in 8.5 percent of the patients in the angioplasty group, as compared with 14.2 percent of those in the fibrinolysis group (P=0.002). The results were similar among patients who were enrolled at invasive-treatment centers: 6.7 percent of the patients in the angioplasty group reached the primary end point, as compared with 12.3 percent in the fibrinolysis group (P=0.05). Among all patients, the better outcome after angioplasty was driven primarily by a reduction in the rate of reinfarction (1.6 percent in the angioplasty group vs. 6.3 percent in the fibrinolysis group, P<0.001); no significant differences were observed in the rate of death (6.6 percent vs. 7.8 percent, P=0.35) or the rate of stroke (1.1 percent vs. 2.0 percent, P=0.15). Ninety-six percent of patients were transferred from referral hospitals to an invasive-treatment center within two hours.

Conclusions A strategy for reperfusion involving the transfer of patients to an invasive-treatment center for primary angioplasty is superior to on-site fibrinolysis, provided that the transfer takes two hours or less.

Source Information

From the Departments of Cardiology at Skejby Hospital, Aarhus University Hospital, Aarhus (H.R.A., T.T.N., L.T., L.R.K.); Aalborg University Hospital, Aalborg (K.R., A.B.V.); Rigshospitalet University Hospital, Copenhagen (H.K., J.K.M., P.G.); Odense University Hospital, Odense (P.T., T.H.); and the Gentofte Hospital, Hellerup (U.A.); the Departments of Medicine at Hilleroed Hospital, Hilleroed (F.P.); Randers Hospital, Randers (P.L.); Aarhus County Hospital and Aarhus University Hospital, Aarhus (S.E.H.); and Horsens Hospital, Horsens (E.V.); the Department of Cardiothoracic Surgery, Gentofte Hospital, Hellerup (H.K.K.); and UNI-C, Danish Information Technology Centre for Education and Research, Aarhus (L.S.M.) — all in Denmark.

Address reprint requests to Dr. Andersen at the Department of Cardiology, Skejby Hospital, Aarhus University Hospital, DK-8200 Aarhus N, Denmark, or at henning.rud.andersen{at}iekf.au.dk.

Full Text of this Article

Related Letters:

Coronary Angioplasty versus Fibrinolytic Therapy in Acute Myocardial Infarction
Channer K. S., Armstrong P. W., Antman E. M., Zaman A. G., Andersen H. R., Nielsen T. T.
Extract | Full Text | PDF  
N Engl J Med 2003; 349:2167-2169, Nov 27, 2003. Correspondence

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