Patients with acute MI should be transferred for angioplasty
The Journal of Family Practice. 2003 December;52(12):919-941
December 1, 2003|Family Medicine
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- BACKGROUND: Several studies have demonstrated the superiority of emergent angioplasty over thrombolysis for acute MI, but these studies took place in experienced angioplasty centers. It has not been clear whether transporting a patient with acute MI to another hospital for angioplasty is better than local care with fibrinolysis.
- POPULATION STUDIED: Researchers enrolled 1572 adult patients diagnosed with acute MI, defined as ST segment elevation in the presence of symptoms for 30 minutes to 12 hours. The study, which took place between 1997 and 2001, included 24 referral hospitals (where angioplasty was not available) and 5 invasive treatment centers (where angioplasty was available) in Denmark.
- STUDY DESIGN AND VALIDITY: Patients were randomized at the presenting hospital to receive immediate coronary angioplasty or tissue plasminogen activator. Both groups received aspirin, an intravenous betablocker, and heparin. If the patient presented to a referral hospital and was randomized to angioplasty, transfer to the nearest angioplasty center had to be completed within 3 hours; a physician accompanied the patient.
- OUTCOMES MEASURED: The primary endpoint was a composite of death, clinical reinfarction, or disabling stroke within 30 days. The researchers also analyzed each of these components separately and performed extensive subgroup analysis.
- RESULTS: The composite endpoint was lower in angioplasty group compared with the thrombolysis group (8.0% vs 13.7%; P<.001) regardless of site of enrollment. The difference was more significant for referral hospitals (8.5% vs 14.2%; P=.002) than at invasive treatment centers (6.7% vs 12.3%; P=.05).
PRACTICE RECOMMENDATIONS
Angioplasty within 2 hours of presentation for acute myocardial infarction (MI) is superior to thrombolysis, primarily due to a lower reinfarction rate. This is true whether a patient presents to a healthcare facility with angioplasty capability or one that transfers a patient.
