Document Detail


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).
MedLine Citation:
PMID:  14532938     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Frantisek Bednár; Petr Widimský; Jirí Krupicka; Ladislav Groch; Michael Aschermann; Michael Zelízko;
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Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  The Canadian journal of cardiology     Volume:  19     ISSN:  0828-282X     ISO Abbreviation:  Can J Cardiol     Publication Date:  2003 Sep 
Date Detail:
Created Date:  2003-10-08     Completed Date:  2003-10-23     Revised Date:  2008-04-09    
Medline Journal Info:
Nlm Unique ID:  8510280     Medline TA:  Can J Cardiol     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  1133-7     Citation Subset:  IM    
Affiliation:
Královské Vinohrady University Hospital, Prague, Czech Republic.
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary / 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:
Can J Cardiol. 2003 Sep;19(10):1119-22   [PMID:  14532936 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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