A1(1414. Armstrong PW, Gershlick AH, Goldstein P, Wilcox R, Danays T, Lambert Y, et al.; STREAM Investigative Team. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med. 2013;368(15):1379–87.)
|
Prehospital FT and PPCI |
Sample: 1892 Prehosp FT: 944 PPCI: 948 |
Tenecteplase |
< 3 hours |
3 |
To verify whether prehospital FT is more effective compared to PPCI in patients with early symptoms. |
The outcomes of death, shock, CHF or reinfarction at 30 days were slightly lower in those who received prehospital FT (12.4%) when compared to those who used PPCI (14.3%). More intracranial hemorrhages were found in the prehospital FT group than in the PPCI group and the other hemorrhages occurred without difference between the groups. |
Prehospital FT resulted in effective reperfusion in patients with STEMI who could not receive primary PCI within one hour after the first contact. Prehospital FT was associated with a slightly higher risk of intracranial bleeding. |
A2(1515. Bonnefoy E, Lapostolle F, Leizorovicz A, Steg G, McFadden EP, Dubien PY, et al.; Comparison of Angioplasty and Prehospital Thromboysis in Acute Myocardial Infarction study group. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet. 2002;360(9336):825–9.)
|
Prehospital FT, rescue PCI and PPCI |
Sample: 840 Prehosp FT: 419 PPCI: 421 |
Alteplase |
≥ 30 minutes and <6 hours. |
3 |
Check if the PPCI is higher than prehospital FT followed by rescue PCI. |
The rate of primary outcomes was 8.2% in the prehospital FT group and 6.2% in the PPCI group. Rescue PCI was performed in 26% of patients who used prehospital FT. There were 16 deaths among patients receiving prehospital FT and 20 among those receiving PPCI. |
The PPCI did not present better results of the outcomes death, reinfarction, and stroke when compared to prehospital FT with transfer to an intervention unit for possible rescue PCI. |
A3(1616. Bonnefoy E, Steg PG, Chabaud S, Dubien PY, Lapostolle F, Boudet F, et al. Is primary angioplasty more effective than prehospital fibrinolysis in diabetics with acute myocardial infarction? Data from the CAPTIM randomized clinical trial. Eur Heart J. 2005;26(17):1712–8.)
|
Prehospital FT, rescue PCI and PPCI |
Sample: 840 D: 103 Prehosp FT: 46 PPCI: 57 ND: 731 Prehosp FT: 370 PPCI: 361 |
Alteplase |
≥ 30 minutes and <6 hours. |
3 |
To assess the impact of diabetic status on the relative benefits of reperfusion strategies. |
Diabetics had a higher risk, with a higher rate of outcomes death, reinfarction, and stroke (14.6 versus 5.6%) and a high mortality (8.7 versus 3.1%) related to hospital FT use in relation to PPCI, when compared to non-diabetics. |
Diabetic patients seen within 6 h after STEMI can benefit from PPCI. |
A4(1717. Bonnefoy E, Steg PG, Boutitie F, Dubien PY, Lapostolle F, Roncalli J, et al.; CAPTIM Investigators. Comparison of primary angioplasty and pre-hospital fibrinolysis in acute myocardial infarction (CAPTIM) trial: a 5-year follow-up. Eur Heart J. 2009;30(13):1598–606.)
|
Prehospital FT, rescue PCI and PPCI |
Sample: 840 Prehosp FT: 419 PPCI: 421 |
Alteplase |
≥ 30 minutes and <6 hours. |
3 |
To investigate the long-term mortality (5 years) of patients included in the study. |
All-cause mortality at 5 years was 9.7% in the prehospital FT group, compared to 12.6% in the PPCI group. For patients seen within two hours, mortality was 5.8% in the prehospital FT group, compared with 11.1% in the PPCI group. In those treated after two hours, the values were 14.5 and 14.4%, respectively. |
For patients treated within two hours after the onset of STEMI, five-year mortality was lower than those treated using prehospital FT in general. |
A5(1818. Steg PG, Bonnefoy E, Chabaud S, Lapostolle F, Dubien PY, Cristofini P, et al.; Comparison of Angioplasty and Prehospital Thrombolysis In acute Myocardial infarction (CAPTIM) Investigators. Impact of time to treatment on mortality after prehospital fibrinolysis or primary angioplasty: data from the CAPTIM randomized clinical trial. Circulation. 2003;108(23):2851–6.)
|
Prehospital FT, rescue PCI and PPCI |
Sample: 840 Prehosp FT: 419 PPCI: 421 <2 h: 460 ≥ 2 h: 374 |
Alteplase |
≥ 30 minutes and <6 hours. |
3 |
To analyze the effect of treatment instituted with prehospital FT or PPCI due to the time elapsed since the onset of symptoms. |
Patients treated up to two hours after symptom onset had lower mortality when treated with fibrinolytic FT compared to those who received PPCI up to 30 days after the event. Those treated after two hours showed no differences for the outcomes of death, reinfarction or stroke by therapeutic modality. |
Prehospital FT may be preferable over PPCI for patients treated within the first two hours after the onset of symptoms. |