Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study.

作者: Eric Bonnefoy , Frédéric Lapostolle , Alain Leizorovicz , Gabriel Steg , Eugène P McFadden

DOI: 10.1016/S0140-6736(02)09963-4

关键词: CardiologyIntention-to-treat analysisSurgeryInternal medicineClinical endpointAbsolute risk reductionStrokeFibrinolysisRandomizationAngioplastyMyocardial infarctionMedicine

摘要: Summary Background Although both prehospital fibrinolysis and primary angioplasty provide a clinical benefit over in-hospital in acute myocardial infarction, they have not been directly compared. Our aim was to find out whether better than fibrinolysis. Methods We did randomised multicentre trial of 840 patients (of 1200 planned) who presented within 6 h infarction with ST-segment elevation, initially managed by mobile emergency-care units. assigned (n=419) accelerated alteplase or (n=421), transferred all centre access emergency angioplasty. endpoint composite death, non-fatal reinfarction, disabling stroke at 30 days. Analyses were intention treat. Findings The median delay between onset symptoms treatment 130 min the prehospital-fibrinolysis group 190 (time first balloon inflation) primary-angioplasty group. Rescue done 26% rate 8·2% (34 patients) 6·2% (26 (risk difference 1·96, 95% CI−1·53 5·46). 16 (3·8%) 20 (4·8%) died (p=0·61). Interpretation A strategy (with transfer an interventional facility for possible rescue angioplasty) presenting early infarction.

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