| Interhospital transport for primary angioplasty improves the long-term outcome of acute myocardial infarction compared with immediate thrombolysis in the nearest hospital (one-year follow-up of the PRAGUE-1 study). | |
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MedLine Citation:
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PMID: 14532938 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVE: Comparison of the long-term outcomes of three reperfusion strategies in patients with acute ST elevation myocardial infarction presenting to community hospitals. METHODS: One-year clinical outcomes were compared for 300 patients randomized in the PRimary Angioplasty in patients transferred from General community hospitals to specialized percutaneous coronary intervention Units with or without Emergency thrombolysis (PRAGUE-1) study to one of three treatment strategies: thrombolysis in a community hospital (group A, n=99); thrombolysis during immediate transportation for coronary angioplasty (group B, n=100); and immediate transportation for coronary angioplasty without thrombolysis (group C, n=101). RESULTS: Total mortality rates in group A, B and C patients were 18%, 12% and 13%, respectively (not significant). Nonfatal reinfarction occurred in 12%, 6% and 3% of patients, respectively (P<0.05). The combined endpoint (total mortality and nonfatal reinfarction rate) was reported in 30%, 18% and 16% of patients, respectively (P<0.05). In patients randomized within 2 h of the onset of symptoms, mortality rates were 18%, 3% and 8%, respectively (P<0.05). Additional revascularization procedures (percutaneous transluminal coronary angioplasty, coronary artery bypass graft surgery) were performed in 35%, 14% and 15% of patients, respectively (P<0.001). CONCLUSIONS: Primary angioplasty (even if delayed due to patient transportation to an interventional centre) is associated with better short- and long-term clinical outcomes than thrombolysis. The combination of the two strategies did not prove superior to coronary angioplasty alone. However, it may be superior in a subset of patients with early admission. The coronary angioplasty strategy decreases the need for revascularization procedures during the subsequent one-year follow-up. |
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Authors:
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Frantisek Bednár; Petr Widimský; Jirí Krupicka; Ladislav Groch; Michael Aschermann; Michael Zelízko; |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: The Canadian journal of cardiology Volume: 19 ISSN: 0828-282X ISO Abbreviation: Can J Cardiol Publication Date: 2003 Sep |
Date Detail:
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Created Date: 2003-10-08 Completed Date: 2003-10-23 Revised Date: 2008-04-09 |
Medline Journal Info:
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Nlm Unique ID: 8510280 Medline TA: Can J Cardiol Country: Canada |
Other Details:
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Languages: eng Pagination: 1133-7 Citation Subset: IM |
Affiliation:
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Královské Vinohrady University Hospital, Prague, Czech Republic. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary
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utilization* Coronary Care Units / utilization Czech Republic / epidemiology Female Follow-Up Studies Hospital Mortality Hospitals, Community / utilization Humans Male Middle Aged Multivariate Analysis Myocardial Infarction / mortality, therapy* Outcome Assessment (Health Care)* Patient Transfer / statistics & numerical data* Risk Factors Thrombolytic Therapy / utilization* |
| Comments/Corrections | |
Comment In:
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Can J Cardiol. 2003 Sep;19(10):1119-22
[PMID:
14532936
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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