Transportation to primary percutaneous coronary intervention, compared with on-site fibrinolysis, is a strong independent predictor of functional status after myocardial infarction: 5-year follow-up of the PRAGUE-2 trial
Language English Country England, Great Britain Media print-electronic
Document type Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't
PubMed
24337919
DOI
10.1177/2048872613516016
PII: 2048872613516016
Knihovny.cz E-resources
- Keywords
- Angina pectoris, fibrinolysis, heart failure, long-term outcome, myocardial infarction, primary coronary intervention,
- MeSH
- Myocardial Infarction physiopathology therapy MeSH
- Hospitals, Community statistics & numerical data MeSH
- Percutaneous Coronary Intervention statistics & numerical data MeSH
- Coronary Care Units statistics & numerical data MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Patient Transfer statistics & numerical data MeSH
- Aged MeSH
- Transportation of Patients statistics & numerical data MeSH
- Thrombolytic Therapy statistics & numerical data MeSH
- Treatment Outcome MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- Comparative Study MeSH
AIMS: Subjective symptoms represent significant criteria of a patient's health condition; therefore, we focused on the long-term prevalence of heart failure symptoms and angina pectoris after myocardial infarction between two groups of patients in which two different therapeutic strategies were used during the acute phase of ST-elevation myocardial infarction (STEMI). METHODS: The PRAGUE-2 study enrolled 850 patients with STEMI. The patients were randomized into two groups - transport to a primary percutaneous coronary intervention (PCI) centre (n=429) vs. fibrinolysis in community hospitals (n=421). The data were collected from either primary hospitals or PCI centres, as well as via questionnaires. RESULTS: The mean follow-up was 58 months. At 5 years, 45.4% of patients were in New York Heart Association class I following primary PCI vs. 31.8% of those treated with fibrinolysis (OR 2.02, 95% CI 1.37-2.97, p<0.002). At 5 years, 83.6% of patients had no symptoms of angina pectoris following invasive therapy vs. 58% of patients treated with fibrinolysis (OR 4.47, 95% CI 2.79-7.18, p<0.001). CONCLUSIONS: The symptoms of angina pectoris and heart failure were significantly lower in patients assigned to primary PCI in the acute stage of myocardial infarction compared with patients treated with fibrinolysis at the 5-year follow up.
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