Document Detail


Transfer with GP IIb/IIIa inhibitor tirofiban for primary percutaneous coronary intervention vs. on-site thrombolysis in patients with ST-elevation myocardial infarction (STEMI): a randomized open-label study for patients admitted to community hospitals.
MedLine Citation:
PMID:  17884846     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: Our study aimed to compare two reperfusion strategies in patients with ST-elevation myocardial infarction (STEMI) admitted initially to a community hospital without catheterization facilities. METHODS AND RESULTS: Four hundred and one patients with STEMI admitted to community hospital (13 hospitals, radius 20-150 km from cath-lab) were randomized to on-site thrombolysis or to transport with tirofiban (10 microg/kg bolus i.v. + i.v. infusion 0.1 microg/kg/min) for primary PCI in single invasive centre. Primary endpoints were total mortality, recurrent MI (re-AMI), and stroke during 1 year follow-up. Delay to reperfusion defined as interval between admission and start of fibrinolysis or primary PCI was 35 and 145 min (P < 0.0001). Mean time of tirofiban administration to PCI in transfer group was: 122.3 +/- 35.7 min. Mortality was not different during hospitalization and at 30th-day, with trend towards lower mortality at 1 year in transport group (12.5 vs. 7.0%, P = 0.061). There were no differences in the rate of re-AMI and stroke, with trend towards lower incidence of re-AMI in transfer group at 1 year (7.5 vs. 3.5%, P = 0.073). Composite of death/re-AMI/stroke was higher in on-site group during follow-up (15.5 vs. 8.0%, P = 0.019; 21.5 vs. 11.4%, P = 0.006, respectively, at 30th-day and 1 year). CONCLUSION: Outcomes at 1 year follow-up suggest that transportation with adjunctive therapy with GP IIb/IIIa inhibitor tirofiban for primary PCI is superior to on-site thrombolysis for patient with STEMI presenting to hospital without catheterization facilities.
Authors:
Slawomir Dobrzycki; Pawel Kralisz; Konrad Nowak; Przemyslaw Prokopczuk; Waclaw Kochman; Janusz Korecki; Boguslaw Poniatowski; Jerzy Zuk; Ewa Sitniewska; Hanna Bachorzewska-Gajewska; Jerzy Sienkiewicz; Wlodzimierz J Musial
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2007-09-20
Journal Detail:
Title:  European heart journal     Volume:  28     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2007 Oct 
Date Detail:
Created Date:  2007-10-22     Completed Date:  2008-04-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  2438-48     Citation Subset:  IM    
Affiliation:
Department of Invasive Cardiology, State Teaching Hospital, Medical University of Bialystok, Sklodowskiej 24a, 15-276 Bialystok, Poland.
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Female
Fibrinolytic Agents / therapeutic use*
Hospitals, Community
Humans
Male
Middle Aged
Myocardial Infarction / mortality,  therapy*
Myocardial Reperfusion / methods
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors,  therapeutic use
Poland
Risk Factors
Survival Rate
Thrombolytic Therapy / methods*
Tyrosine / analogs & derivatives*,  therapeutic use
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 144494-65-5/tirofiban; 55520-40-6/Tyrosine

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