Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction

Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction

Autor Armstrong, Paul W. Google Scholar
Gershlick, Anthony H. Google Scholar
Goldstein, Patrick Google Scholar
Wilcox, Robert Google Scholar
Danays, Thierry Google Scholar
Lambert, Yves Google Scholar
Sulimov, Vitaly Google Scholar
Rosell Ortiz, Fernando Google Scholar
Ostojic, Miodrag Google Scholar
Welsh, Robert C. Google Scholar
Carvalho, Antonio C. Autor UNIFESP Google Scholar
Nanas, John Google Scholar
Arntz, Hans-Richard Google Scholar
Halvorsen, Sigrun Google Scholar
Huber, Kurt Google Scholar
Grajek, Stefan Google Scholar
Fresco, Claudio Google Scholar
Bluhmki, Erich Google Scholar
Regelin, Anne Google Scholar
Vandenberghe, Katleen Google Scholar
Bogaerts, Kris Google Scholar
Van de Werf, Frans Google Scholar
STREAM Investigative Team Google Scholar
Instituição Univ Alberta
Univ Hosp Leicester Trust
Univ Nottingham
Lille Univ Hosp
Boehringer Ingelheim GmbH & Co KG
Ctr Hosp Versailles
Mobile Intens Care Unit
First Moscow State Med Univ
Empresa Publ Emergencias Sanitarias
Univ Belgrade
Universidade Federal de São Paulo (UNIFESP)
Univ Athens
Benjamin Franklin Med Ctr
Univ Oslo
Wilhelminenhosp
Poznan Univ Med Sci
Azienda Osped Univ Udine
Katholieke Univ Leuven
Univ Hasselt
Resumo BACKGROUNDIt is not known whether prehospital fibrinolysis, coupled with timely coronary angiography, provides a clinical outcome similar to that with primary percutaneous coronary intervention (PCI) early after acute ST-segment elevation myocardial infarction (STEMI).METHODSAmong 1892 patients with STEMI who presented within 3 hours after symptom onset and who were unable to undergo primary PCI within 1 hour, patients were randomly assigned to undergo either primary PCI or fibrinolytic therapy with bolus tenecteplase (amended to half dose in patients >= 75 years of age), clopidogrel, and enoxaparin before transport to a PCI-capable hospital. Emergency coronary angiography was performed if fibrinolysis failed; otherwise, angiography was performed 6 to 24 hours after randomization. the primary end point was a composite of death, shock, congestive heart failure, or reinfarction up to 30 days.RESULTSThe primary end point occurred in 116 of 939 patients (12.4%) in the fibrinolysis group and in 135 of 943 patients (14.3%) in the primary PCI group (relative risk in the fibrinolysis group, 0.86; 95% confidence interval, 0.68 to 1.09; P = 0.21). Emergency angiography was required in 36.3% of patients in the fibrinolysis group, whereas the remainder of patients underwent angiography at a median of 17 hours after randomization. More intracranial hemorrhages occurred in the fibrinolysis group than in the primary PCI group (1.0% vs. 0.2%, P = 0.04; after protocol amendment, 0.5% vs. 0.3%, P = 0.45). the rates of nonintracranial bleeding were similar in the two groups.CONCLUSIONSPrehospital fibrinolysis with timely coronary angiography resulted in effective reperfusion in patients with early STEMI who could not undergo primary PCI within 1 hour after the first medical contact. However, fibrinolysis was associated with a slightly increased risk of intracranial bleeding. (Funded by Boehringer Ingelheim; ClinicalTrials.gov number, NCT00623623.)
Idioma Inglês
Financiador Boehringer Ingelheim
Eli Lilly
Merck
Roche
Daiichi Sankyo
Medicines Company
AstraZeneca
Sanofi
Bayer
Schering-Plough
Sanofi-Aventis
Bristol-Myers Squibb
Abbott
Medtronic
Edwards Lifesciences
Servier
Pfizer
Data de publicação 2013-04-11
Publicado em New England Journal of Medicine. Waltham: Massachusetts Medical Soc, v. 368, n. 15, p. 1379-1387, 2013.
ISSN 0028-4793 (Sherpa/Romeo, fator de impacto)
Publicador Massachusetts Medical Soc
Extensão 1379-1387
Fonte http://dx.doi.org/10.1056/NEJMoa1301092
Direito de acesso Acesso restrito
Tipo Artigo
Web of Science WOS:000317333600005
Endereço permanente http://repositorio.unifesp.br/handle/11600/36203

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