| Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. | |
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MedLine Citation:
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PMID: 12243916 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Although both prehospital fibrinolysis and primary angioplasty provide a clinical benefit over in-hospital fibrinolysis in acute myocardial infarction, they have not been directly compared. Our aim was to find out whether primary angioplasty was better than prehospital fibrinolysis. METHODS: We did a randomised multicentre trial of 840 patients (of 1200 planned) who presented within 6 h of acute myocardial infarction with ST-segment elevation, initially managed by mobile emergency-care units. We assigned patients to prehospital fibrinolysis (n=419) with accelerated alteplase or primary angioplasty (n=421), and transferred all to a centre with access to emergency angioplasty. Our primary endpoint was a composite of death, non-fatal reinfarction, and non-fatal disabling stroke at 30 days. Analyses were by intention to treat. FINDINGS: The median delay between onset of symptoms and treatment was 130 min in the prehospital-fibrinolysis group and 190 min (time to first balloon inflation) in the primary-angioplasty group. Rescue angioplasty was done in 26% of the patients in the fibrinolysis group. The rate of the primary endpoint was 8.2% (34 patients) in the prehospital-fibrinolysis group and 6.2% (26 patients) in the primary-angioplasty group (risk difference 1.96, 95% CI -1.53 to 5.46). 16 (3.8%) patients assigned prehospital fibrinolysis and 20 (4.8%) assigned primary angioplasty died (p=0.61). INTERPRETATION: A strategy of primary angioplasty was not better than a strategy of prehospital fibrinolysis (with transfer to an interventional facility for possible rescue angioplasty) in patients presenting with early myocardial infarction. |
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Authors:
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Eric Bonnefoy; Frédéric Lapostolle; Alain Leizorovicz; Gabriel Steg; Eugène P McFadden; Pierre Yves Dubien; Simon Cattan; Eric Boullenger; Jacques Machecourt; Jean-Micel Lacroute; Jean Cassagnes; François Dissait; Paul Touboul; |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Lancet Volume: 360 ISSN: 0140-6736 ISO Abbreviation: Lancet Publication Date: 2002 Sep |
Date Detail:
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Created Date: 2002-09-23 Completed Date: 2002-10-09 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 2985213R Medline TA: Lancet Country: England |
Other Details:
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Languages: eng Pagination: 825-9 Citation Subset: AIM; IM |
Affiliation:
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Coronary Care Unit, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary* / statistics & numerical data Cause of Death Combined Modality Therapy Emergency Medical Services* / statistics & numerical data Female France Humans Male Middle Aged Mobile Health Units Myocardial Infarction / mortality, therapy* Outcome and Process Assessment (Health Care) Recurrence Survival Rate Thrombolytic Therapy* / statistics & numerical data Time and Motion Studies |
| Comments/Corrections | |
Comment In:
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Lancet. 2002 Sep 14;360(9336):814-6
[PMID:
12243913
]
Lancet. 2003 Jan 4;361(9351):77-8; author reply 78-9 [PMID: 12517491 ] Lancet. 2003 Jan 4;361(9351):78; author reply 78-9 [PMID: 12517492 ] ACP J Club. 2003 Mar-Apr;138(2):31 [PMID: 12614116 ] Lancet. 2003 Feb 22;361(9358):700; author reply 701 [PMID: 12606194 ] Lancet. 2003 Feb 22;361(9358):700-1; author reply 701 [PMID: 12606193 ] Lancet. 2003 Mar 15;361(9361):966-7; author reply 967-8 [PMID: 12648990 ] Lancet. 2003 Mar 15;361(9361):965-6; author reply 967-8 [PMID: 12648988 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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