Multicentre randomized trial comparing transport to primary angioplasty vs immediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory. The PRAGUE study.

摘要: Background Primary coronary angioplasty is an effective reperfusion strategy in acute myocardial infarction. However, its availability limited, and transporting patients to centre the phase of infarction has not yet been proved safe. Methods The PRAGUE study (PRimary Angioplasty transferred from General community hospitals specialized PTCA Units with or without Emergency thrombolysis) compared three strategies infarction, presenting within 6h symptom onset at a catheterization laboratory: group A—thrombolytic therapy (n=99), B—thrombolytic during transportation (n=100), C—immediate for primary pre-treatment thrombolysis (n=101). Results No complications occurred C. Two ventricular fibrillations B. Median admission–reperfusion time transported (group B 106min, C 96min) favourably anticipated >90min A. combined end-point (death/reinfarction/stroke 30 days) was less frequent (8%) groups (15%) A (23%, P <0·02). incidence reinfarction markedly reduced by transport (1% vs 7% 10% A, <0·03). Conclusions Transferring tertiary feasible safe. This associated significant reduction clinical death/reinfarction/stroke days when standard thrombolytic hospital.