Long distance transport for primary angioplasty vs immediate thrombolysis in acute myocardial infarction. Final results of the randomized national multicentre trial--PRAGUE-2
Language English Country Great Britain, England Media print
Document type Clinical Trial, Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
PubMed
12559941
DOI
10.1016/s0195-668x(02)00468-2
PII: S0195668X02004682
Knihovny.cz E-resources
- MeSH
- Survival Analysis MeSH
- Angioplasty, Balloon, Coronary methods MeSH
- Time Factors MeSH
- Length of Stay MeSH
- Ventricular Dysfunction, Left etiology MeSH
- Physical Examination methods MeSH
- Myocardial Infarction mortality therapy MeSH
- Middle Aged MeSH
- Humans MeSH
- Hospital Mortality MeSH
- Professional Practice MeSH
- Transportation of Patients methods MeSH
- Thrombolytic Therapy methods MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
BACKGROUND: Primary percutaneous coronary intervention (PCI) is shown to be the most effective reperfusion strategy in acute myocardial infarction. The aim of this multicentre national randomized mortality trial was to test whether the nationwide change in treatment guidelines (transportation of all patients to PCI centres) was warranted. METHODS: The PRAGUE-2 study randomized 850 patients with acute ST elevation myocardial infarction presenting within <12 h to the nearest community hospital without a catheter laboratory to either thrombolysis in this hospital (TL group, n=421) or immediate transport for primary percutaneous coronary intervention (PCI group, n=429). The primary end-point was 30-day mortality. Secondary end-points were: death/reinfarction/stroke at 30 days (combined end-point) and 30-day mortality among patients treated within 0-3 h and 3-12 h after symptom onset. Maximum transport distance was 120 km. RESULTS: Five complications (1.2%) occurred during the transport. Randomization-balloon time in the PCI group was 97+/-27 min, and randomization-needle time in the TL group was 12+/-10 min. Mortality at 30 days was 10.0% in the TL group compared to 6.8% mortality in the PCI group (P=0.12, intention-to-treat analysis). Mortality of 380 patients who actually underwent PCI was 6.0% vs 10.4% mortality in 424 patients who finally received TL (P<0.05). Among 299 patients randomized >3 h after the onset of symptoms, the mortality of the TL group reached 15.3% compared to 6% in the PCI group (P<0.02). Patients randomized within <3 h of symptom onset (n=551) had no difference in mortality whether treated by TL (7.4%) or transferred to PCI (7.3%). A combined end-point occurred in 15.2% of the TL group vs 8.4% of the PCI group (P<0.003). CONCLUSIONS: Long distance transport from a community hospital to a tertiary PCI centre in the acute phase of AMI is safe. This strategy markedly decreases mortality in patients presenting >3 h after symptom onset. For patients presenting within <3 h of symptoms, TL results are similar results to long distance transport for PCI.
References provided by Crossref.org
Risk Stratification of Patients with Acute Coronary Syndrome
Stent for Life Initiative: where are we standing and where are we going?
How to treat patients with ST-elevation acute myocardial infarction and multi-vessel disease?
Myocardial ischemic injury and protection
