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Updated: Jun 23, 2026
05:52
Prehospital Thrombolysis: A Manual from Berlin
Published on: November 27, 2013
Transfer with GP IIb/IIIa inhibitor tirofiban for primary percutaneous coronary intervention vs. on-site thrombolysis
Slawomir Dobrzycki1, Pawel Kralisz, Konrad Nowak
1Department of Invasive Cardiology, State Teaching Hospital, Medical University of Bialystok, Sklodowskiej 24a, 15-276 Bialystok, Poland.
European Heart Journal
|September 22, 2007
Summary
Transferring ST-elevation myocardial infarction (STEMI) patients for primary PCI with tirofiban improved 1-year outcomes compared to on-site thrombolysis. This strategy reduced composite endpoints of death, recurrent MI, and stroke.
Area of Science:
- Cardiology
- Emergency Medicine
- Clinical Trials
Background:
- ST-elevation myocardial infarction (STEMI) requires timely reperfusion.
- Community hospitals often lack immediate percutaneous coronary intervention (PCI) facilities.
- Evaluating reperfusion strategies is crucial for STEMI patients presenting to non-PCI-capable hospitals.
Purpose of the Study:
- To compare on-site thrombolysis versus transport for primary PCI with tirofiban in STEMI patients.
- To assess the impact of these strategies on mortality, recurrent MI, and stroke.
- To determine the optimal reperfusion approach for STEMI patients in resource-limited settings.
Main Methods:
- Randomized trial of 401 STEMI patients from 13 community hospitals.
- Interventions: on-site thrombolysis or transport with tirofiban for primary PCI.
- Primary endpoints: 1-year mortality, recurrent MI (re-AMI), and stroke.
Main Results:
- Significantly shorter reperfusion delay in the on-site thrombolysis group (35 min vs. 145 min).
- Transport group showed a trend towards lower 1-year mortality (7.0% vs. 12.5%) and re-AMI (3.5% vs. 7.5%).
- Composite of death/re-AMI/stroke was significantly lower at 30 days (8.0% vs. 15.5%) and 1 year (11.4% vs. 21.5%) in the transport group.
Conclusions:
- Transportation with tirofiban for primary PCI is superior to on-site thrombolysis for STEMI patients.
- This strategy leads to better long-term outcomes, reducing major adverse events.
- Optimizing patient transfer protocols is vital for improving STEMI care in community hospitals.
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