Primary PCI vs. prehospital lysis for MI: similar survival


NEW YORK (Reuters Health), Aug 19 - Five-year survival is similar whether patients with acute myocardial infarction (MI) are treated with primary percutaneous coronary intervention (PCI) or prehospital lysis followed by transfer to an interventional facility.

The exception is patients treated within two hours of symptom onset, Dr. Eric Bonnefoy, from Hospices Civils de Lyon, France, and colleagues note. In this group, five-year mortality was significantly lower with prehospital lysis: 5.8% versus 11.1% with primary PCI (p = 0.018).

The Comparison of Primary Angioplasty and Pre-hospital Fibrinolysis in Acute Myocardial Infarction (CAPTIM) trial featured 840 patients who were managed in mobile intensive care units within six hours of ST-segment elevation MI. The subjects were randomized to undergo primary PCI or prehospital fibrinolysis with immediate transfer to an interventional center.

Initial data from CAPTIM showed similar 30-day survival rates for both groups. For the five-year analysis, data was available for 795 patients (94.6%).

All-cause mortality in the fibrinolysis and primary PCI groups were 9.7% and 12.6%, respectively (p = NS), according to the report in the July issue of the European Heart Journal. The lack of a significant difference was due to most patients having a treatment delay of longer than two hours, and for such patients, each approach had nearly identical five-year mortality, roughly 14.5%.

In contrast to other large studies comparing lysis with primary PCI, CAPTIM involved mobile intensive care and immediate transfer for catheterization. Therefore, the investigators point out, "These data do not challenge the general consensus concerning the superiority of timely PCI over in-hospital fibrinolysis."

The results do, however, "underline that different reperfusion strategies might bring similar results at the acute phase of a MI when an appropriate pre-hospital organization is operative," the authors conclude.

Eur Heart J 2009;30:1598-1606.

Last Updated: 2009-08-18 11:30:13 -0400 (Reuters Health)

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