David Massel, MD; Patrick J. Teefy, MD
In patients with ST-segment elevation myocardial infarction (STEMI), does transfer for percutaneous coronary intervention (PCI) reduce 30-day mortality more than on-site thrombolysis?
Included studies compared transfer for PCI with on-site thrombolysis and reported complete data on survival. Trials that transferred patients for PCI ≤ 6 hours after starting thrombolysis were included. Outcomes were mortality, reinfarction, and stroke, all assessed at 30 days.
MEDLINE, EMBASE/Excerpta Medica, and Cochrane Central Register of Controlled Trials (all 1990 to Apr 2008); and several scientific session abstracts were searched for randomized controlled trials (RCTs). Authors were contacted for additional data. 11 RCTs (n = 5741) met the selection criteria. 4 studies scored > 8 (median score) on a 10-item study quality scale and were considered high quality. 9 studies randomized patients at a community hospital, 1 randomized patients out of hospital, and 1 randomized patients in primary PCI centers, referral hospitals, or out of hospital.
The main results are in the Table.
In patients with ST-segment elevation myocardial infarction, transfer for percutaneous coronary intervention reduces 30-day mortality more than on-site thrombolysis.
Transfer for primary PCI vs on-site thrombolysis in STEMI*
*PCI = percutaneous coronary intervention; STEMI = ST-segment elevation myocardial infarction; other abbreviations defined in Glossary. Weighted event rates, RRR, NNT, and CI calculated from data in article using a fixed-effect model.
†High-quality studies scored > 8 on a 10-item quality scale.
Massel D, Teefy PJ. Review: Transfer for PCI reduces 30-day mortality more than on-site thrombolysis in STEMI. Ann Intern Med. ;150:JC4–4. doi: 10.7326/0003-4819-150-8-200904210-02004
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Published: Ann Intern Med. 2009;150(8):JC4-4.
Acute Coronary Syndromes, Cardiology, Coronary Heart Disease, Emergency Medicine, Percutaneous Coronary Intervention.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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