| Primary angioplasty in acute myocardial infarction at hospitals with no surgery on-site (the PAMI-No SOS study) versus transfer to surgical centers for primary angioplasty. | |
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MedLine Citation:
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PMID: 15172395 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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OBJECTIVES: To investigate primary angioplasty (PA) for high-risk acute myocardial infarction (AMI) at hospitals with no cardiac surgery on-site (No SOS), we hypothesized that a nonrandomized registry of such patients treated with PA would show clinical outcomes similar to those of a group randomized to transfer for PA, and that reperfusion would occur faster. BACKGROUND: Primary angioplasty provides outcomes superior to fibrinolytic therapy in AMI, but its use in community hospitals with No SOS has been limited. METHODS: Fibrinolytic-eligible patients with high-risk AMI prospectively consented if they had one or more high-risk characteristic. Nineteen hospitals with No SOS prospectively enrolled 500 patients for PA on-site. Seventy-one similar Air Primary Angioplasty in Myocardial Infarction trial patients were randomized to transfer for PA. RESULTS: Primary angioplasty was performed in 88% of patients. Patients transferred for PA had a longer mean time to treatment (187 vs. 120 min; p < 0.0001). Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was achieved in 96% for on-site PA, 86% in the transfer group (p = 0.004). The combined primary end point of 30-day mortality, re-infarction, and disabling stroke occurred in 27 (5%) on-site PA patients and 6 (8.5%) transfer patients (p = 0.27). Unadjusted one-year mortality was improved in on-site PA patients compared with those transferred (6% vs. 13%, p = 0.043), but after adjustment for differences in baseline variables, this difference was not significant. CONCLUSIONS: On-site PA and transfer groups had similar 30-day outcomes and more rapid reperfusion for on-site PA. Primary angioplasty in high-risk AMI patients at hospitals with No SOS is safe, effective, and faster than PA after transfer to a surgical facility. |
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Authors:
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Thomas P Wharton; Lorelei L Grines; Mark A Turco; James D Johnston; Jane Souther; David C Lew; Ajazuddin Z Shaikh; William Bilnoski; Sushil K Singhi; A Ersin Atay; Nancy Sinclair; Dawn E Shaddinger; Mark Barsamian; Mariann Graham; Judith Boura; Cindy L Grines |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Multicenter Study; Randomized Controlled Trial |
Journal Detail:
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Title: Journal of the American College of Cardiology Volume: 43 ISSN: 0735-1097 ISO Abbreviation: J. Am. Coll. Cardiol. Publication Date: 2004 Jun |
Date Detail:
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Created Date: 2004-06-02 Completed Date: 2004-06-17 Revised Date: 2004-11-17 |
Medline Journal Info:
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Nlm Unique ID: 8301365 Medline TA: J Am Coll Cardiol Country: United States |
Other Details:
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Languages: eng Pagination: 1943-50 Citation Subset: AIM; IM |
Affiliation:
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Division of Cardiology, Exeter Hospital, Exeter, New Hampshire, USA. tom.wharton@comcast.net |
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* Female Humans Male Middle Aged Myocardial Infarction / mortality, therapy* Operating Rooms* Outcome Assessment (Health Care)* Patient Transfer / utilization* Prospective Studies Registries Time Factors United States Waiting Lists |
| Comments/Corrections | |
Comment In:
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J Am Coll Cardiol. 2004 Jun 2;43(11):1951-3
[PMID:
15172396
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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