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Fibrinolysis versus primary percutaneous intervention in ST-elevation myocardial infarction with long interhospital

Abhimanyu Beri1, Mary Printz, Ansar Hassan

  • 1East Carolina University/Pitt County Memorial Hospital, Greenville, North Carolina, USA. abhiberi@gmail.com

Clinical Cardiology
|March 18, 2010
PubMed

Insights

For ST-elevation myocardial infarction (STEMI) patients requiring long-distance transfer, pre-transfer fibrinolysis did not delay treatment or worsen outcomes compared to direct transfer for primary percutaneous coronary intervention (pPCI). This approach is safe and effective in longer transfer scenarios.

Area of Science:

  • Cardiology
  • Emergency Medicine
  • Interventional Cardiology

Background:

  • Current guidelines advocate for rapid reperfusion therapy in ST-elevation myocardial infarction (STEMI).
  • Primary percutaneous coronary intervention (pPCI) is preferred over fibrinolysis for STEMI, especially with short transfer distances.
  • Outcomes for STEMI patients with longer transfer times receiving pre-transfer fibrinolysis are not well-established.

Purpose of the Study:

  • To evaluate the impact of administering fibrinolysis before interhospital transfer for STEMI on transfer times and patient outcomes.
  • To compare outcomes between STEMI patients receiving pre-transfer fibrinolysis versus direct transfer for pPCI in longer transfer scenarios.

Main Methods:

  • A retrospective analysis of 259 STEMI patients transferred to a pPCI-capable center.
  • Patients were divided into two groups: direct pPCI transfer (43 patients) and pre-transfer fibrinolysis (216 patients).
  • Primary endpoint was door-to-door time; secondary endpoints included stroke, death, bleeding, and combined adverse events.

Main Results:

  • Door-to-door times were similar between the pPCI and fibrinolysis groups (135 vs. 128 minutes, P=0.71).
  • In-hospital mortality was significantly lower in the fibrinolysis group (1.9%) compared to the pPCI group (9.3%, P=0.03).
  • Combined incidence of stroke, significant bleeding, and death was not significantly different between groups (14% vs. 7%, P=0.13).

Conclusions:

  • Pre-transfer fibrinolysis for STEMI patients in longer transfer settings does not significantly delay transfer times.
  • This strategy does not appear to lead to worse clinical outcomes compared to direct transfer for pPCI.
  • Fibrinolysis followed by transfer may be a viable option for STEMI patients when pPCI is not immediately available due to distance.
Abstract

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