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Primary PCI vs. pre-hospital lysis for MI: similar survival

Reuters Health • The Doctor's Channel Daily Newscast

NEW YORK (Reuters Health) – Five-year survival is similar whether patients with acute MI are treated with primary percutaneous coronary intervention (PCI) or pre-hospital lysis followed by transfer to an interventional facility.

The exception is patients treated within 2 hours of symptom onset, Dr. Eric Bonnefoy, from Hospices Civils de Lyon, France, and colleagues note. In this group, 5-year mortality was significantly lower with pre-hospital lysis: 5.8% vs. 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 6 hours of ST-segment elevation MI. The subjects were randomized to undergo primary PCI or pre-hospital fibrinolysis with immediate transfer to an interventional center.

Initial data from CAPTIM showed similar 30-day survival rates for both groups. For the 5-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 the fact that most patients had a treatment delay of longer than 2 hours and for such patients, each approach had nearly identical 5-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.

Reference:
Eur Heart J 2009;30:1598-1606.