A comparison of pharmacologic therapy with/without timely coronary intervention vs. primary percutaneous intervention
1Canadian VIGOUR Centre, 2-51 Medical Sciences Building, University of Alberta Edmonton, AB, Canada T6G 2H7. paul.armstrong@ualberta.ca
European Heart Journal
|June 8, 2006
Summary
Early pharmacologic therapy for ST-elevation myocardial infarction (MI) was comparable to primary percutaneous coronary intervention (PCI). Rapidly delivered drug treatments, with planned intervention, showed similar outcomes to timely PCI for STEMI patients.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Trials
Background:
- Optimal reperfusion strategy for ST-elevation myocardial infarction (STEMI) remains under investigation.
- Early treatment initiation is critical for improving outcomes in STEMI patients.
Purpose of the Study:
- To evaluate if early, pre-hospital pharmacologic therapy is non-inferior to primary percutaneous coronary intervention (PCI) for STEMI.
- To assess the feasibility of pre-hospital randomization and treatment in a multi-center STEMI study.
Main Methods:
- A four-city Canadian open-label randomized feasibility study (WEST) involving 304 STEMI patients within 6 hours of symptom onset.
- Patients received aspirin and enoxaparin, then randomized to: (A) tenecteplase (TNK) + usual care, (B) TNK + routine invasive study within 24 hours, or (C) primary PCI.
- Primary outcome was a composite of 30-day death, re-infarction, and other major adverse cardiac events.
Main Results:
- Treatment times were rapid: TNK groups at 113-130 minutes, primary PCI at 176 minutes.
- 30-day composite outcomes were similar: 25% (A), 24% (B), 23% (C).
- Group A had higher death/recurrent MI rates (13.0%) vs. Group C (4.0%, P=0.021), but Group B (6.7%) did not differ from Group C.
Conclusions:
- Rapidly delivered pharmacologic therapy with planned subsequent intervention may be a viable alternative to primary PCI for STEMI.
- This strategy, emphasizing pre-hospital treatment, demonstrated feasibility and comparable short-term outcomes to timely PCI.
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