Document Detail


Transport for abciximab facilitated primary angioplasty versus on-site thrombolysis with a liberal rescue policy: the randomised Holland Infarction Study (HIS).
MedLine Citation:
PMID:  16786231     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: As of to date, the only large transportation trial comparing on-site fibrin-specific thrombolysis with transfer for primary angioplasty in patients presenting in a referral centre is the DANAMI-2 trial, with only 3% rescue angioplasty. The Holland Infarction Study (HIS) compared abciximab facilitated primary angioplasty (FP) with on-site fibrin-specific thrombolytic therapy (TT) with a liberal protocol-driven rescue angioplasty (transport to intervention centre in case < 50% ST resolution at 60 min). METHODS AND RESULTS: Patients in a referral centre without shock and < 4.5 h of chest pain presenting with ST-elevation having > or = 12 mm ST-segment shift were randomised to either strategy. Of the originally planned 900 patients only 48 were included due to suspension of financial funding. Death, recurrent MI and stroke at one year was 8% for the FP-group and 22% for the TT-group (p = 0.2). Two hours after randomisation the rates of complete ST-segment resolution (> or =70%) were 52% and 35%, respectively (p = 0.2). CONCLUSION: This prematurely discontinued randomised transportation trial shows favorable trends with respect to long-term clinical outcome and early ST-resolution for abciximab facilitated primary angioplasty. In view of the real world delays associated with interhospital transport for primary angioplasty, treatment strategies focusing on early fibrin-specific lysis with a liberal selective rescue policy are warranted.
Authors:
Hendrik-Jan Dieker; Elvira V van Horssen; Ferry M R J Hersbach; Marc A Brouwer; Ad J van Boven; Arnoud W J van 't Hof; Wim R M Aengevaeren; Freek W A Verheugt; Frits W H M Bär
Publication Detail:
Type:  Comparative Study; Journal Article; Meta-Analysis; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Journal of thrombosis and thrombolysis     Volume:  22     ISSN:  0929-5305     ISO Abbreviation:  J. Thromb. Thrombolysis     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-06-20     Completed Date:  2006-10-02     Revised Date:  2007-08-27    
Medline Journal Info:
Nlm Unique ID:  9502018     Medline TA:  J Thromb Thrombolysis     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  39-45     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. h.dieker@cardio.umcn.nl
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty*
Antibodies, Monoclonal / therapeutic use*
Female
Fibrinolytic Agents / therapeutic use*
Humans
Immunoglobulin Fab Fragments / therapeutic use*
Male
Middle Aged
Myocardial Infarction* / drug therapy,  mortality,  surgery
Netherlands
Outcome Assessment (Health Care)
Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors
Thrombolytic Therapy* / mortality
Transportation of Patients*
Treatment Failure
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Fibrinolytic Agents; 0/Immunoglobulin Fab Fragments; 0/Platelet Glycoprotein GPIIb-IIIa Complex; 143653-53-6/abciximab

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


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