Early ST elevation myocardial infarction in non-capable percutaneous coronary intervention centres: In situ fibrinolysis vs. percutaneous coronary intervention transfer

Xavier Carrillo, Eduard Fernandez-Nofrerias, Oriol Rodriguez-Leor, Teresa Oliveras, Jordi Serra, Josepa Mauri, Antoni Curos, Ferran Rueda, Cosme García-García, Ricard Tresserras, Alba Rosas, Maria Teresa Faixedas, Antoni Bayes-Genis

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Abstract

© The Author 2015. Aims The preferred reperfusion strategy for early ST elevation myocardial infarction (STEMI, defined as time from symptoms onset ≤120 min) in non-capable percutaneous coronary intervention (PCI) centres remains controversial. We sought to compare mortality of in situ fibrinolysis vs. PCI transfer in a real-life consecutive cohort of early STEMI. Methods and results Prospective multicentre STEMI registry (Catalonia 'Codi IAM' network) of all-comers in a non-capable PCI centre with symptom onset to first medical contact (FMC) <120 min. Two groups were identified: in situ fibrinolysis and transfer to a PCI-capable centre. Primary endpoint was 30-day mortality. We included 2470 patients, of whom 2227 (90.2%) and 243 (9.8%) comprised the transfer and fibrinolysis groups, respectively. In the fibrinolysis group, diagnostic and system delays were shorter (24 vs. 31 min, P < 0.001; 45 vs. 119 min, P < 0.001, respectively). Thirty-day mortality was 7.7 and 5.1% in fibrinolysis and transfer groups, respectively (P = 0.09). However, patients in the transfer group whose time FMC-device was achieved within 140 min were associated with significantly lower mortality (2.0% for FMC-device <99 min, and 4.6% for FMC-device 99-140 min; P < 0.01 and P = 0.03, respectively vs. fibrinolysis). In multivariable logistic regression analysis, reperfusion with fibrinolysis was an independent 30-day mortality predictive factor (odds ratio: 1.91, 95% confidence interval: 1.01-3.50; P = 0.04), together with age and Killip-Kimball class (both P < 0.001). Conclusions In early STEMI patients assisted in non-capable PCI centres, in situ fibrinolysis had worse prognosis than patient transfer. Transfer to a PCI-capable centre seems recommended in patients with FMC-device delay <140 min.
Original languageEnglish
Pages (from-to)1034-1040
JournalEuropean Heart Journal
Volume37
Issue number13
DOIs
Publication statusPublished - 1 Apr 2016

Keywords

  • Codi IAM
  • Fibrinolysis
  • Primary angioplasty
  • STEMI
  • STEMI network

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    Carrillo, X., Fernandez-Nofrerias, E., Rodriguez-Leor, O., Oliveras, T., Serra, J., Mauri, J., Curos, A., Rueda, F., García-García, C., Tresserras, R., Rosas, A., Faixedas, M. T., & Bayes-Genis, A. (2016). Early ST elevation myocardial infarction in non-capable percutaneous coronary intervention centres: In situ fibrinolysis vs. percutaneous coronary intervention transfer. European Heart Journal, 37(13), 1034-1040. https://doi.org/10.1093/eurheartj/ehv619