Immediate Fibrinolysis Compared with Delayed Primary PCI

A proof-of-concept study suggests that early initiation of a lytic is an acceptable alternative to primary PCI in patients who present to non–PCI-capable hospitals.

The optimal treatment strategy for patients with ST-segment-elevation myocardial infarction (STEMI) who present to hospitals that lack percutaneous coronary intervention (PCI) capability is unclear. In this manufacturer-sponsored multicenter study, 1892 STEMI patients presenting within 3 hours of symptom onset who could not undergo primary PCI within 1 hour were randomized to transport for PCI as soon as feasible or to prompt tenecteplase administration followed by coronary angiography within 24 hours. The lysis group also received enoxaparin and dual antiplatelet therapy. The primary endpoint was the 30-day rate of death, shock, congestive heart failure, or reinfarction.

Eighty-one percent of randomizations occurred prehospital in an ambula…

Reviewing Author

Howard C. Herrmann, MD

Disclosures

Consultant/Advisory BoardAffluent Medical; Artedrone; Caranx; Johnson & Johnson; Medtronic; Prolifagen; Wells Fargo

EquityMicrointerventional Devices, Inc.

RoyaltiesUniversity of Pennsylvania

Grant/Research SupportAbbott Vascular; Edwards Lifesciences; Johnson & Johnson; Medtronic

Editorial BoardsCatheterization and Cardiovascular Interventions; Journal of the American College of Cardiology; Circulation: Cardiovascular Interventions; JACC Cardiovascular Interventions; JACC Case Reports; JSCAI

Leadership Positions in Professional SocietiesHeart Valve Collaboratory (Scientific Committee Member, Chair of the Publications Committee)