Fibrinolysis versus primary percutaneous intervention in ST-elevation myocardial infarction with long interhospital transfer distances

Abstract

Background: Current guidelines recommend rapid initiation of reperfusion therapy for ST-elevationmyocardial infarction (STEMI), withshort-distance transfer forprimarypercutaneouscoronary intervention(pPCI) preferred over fibrinolysis in non - pPCI-capable hospitals. Comparative outcomes in patientswith longer transfer times are unclear. Hypothesis: We designed this study to assess whether administering fibrinolytics prior to initiating longer-distance interhospital transfer in patientswith STEMI leads to a delay in transferor worse outcomes compared with transfer for pPCI. Methods: We analyzed 259 STEMI patients transferred to a receiving pPCI-capable center in eastern North Carolina. The patients were divided into 2 groups, with 43 (16.6%) transferred for pPCI and the remaining 216 (83.4%) transferred following fibrinolysis. The primary endpoint was door-to-door time. We also compared stroke, death, significant bleeding, and combined outcomes between the 2 groups. Results: The median door-to-door time was similar for pPCI and fibrinolysis patients (135 vs 128 minutes; P = 0.71).Median door-to-balloon time among pPCI patientswas 182 minutes from the point of arrival at the referral hospital and 49 minutes from arrival at the receiving pPCI center. Median door-to-needle time in the fibrinolysis patientswas 30 minutes, with rescue PCI eventually performed in 81 (37.5%) patients. In-hospital mortality was higher in patients with pPCI (9.3%) compared with fibrinolysis patients (1.9%; P = 0.03). Combined incidence of stroke, significant bleeding, and death was 14% in pPCI patients compared with 7% in fibrinolysis patients (P = 0.13). Conclusions: In settings with longer transfer distances, administering fibrinolytics prior to transfer to a pPCI-capable center did not cause any significant delay in transfer or worse outcomes. © 2010 Wiley Periodicals, Inc.