Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction

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dc.contributor.author Armstrong, Paul W.
dc.contributor.author Gershlick, Anthony H.
dc.contributor.author Goldstein, Patrick
dc.contributor.author Wilcox, Robert
dc.contributor.author Danays, Thierry
dc.contributor.author Lambert, Yves
dc.contributor.author Sulimov, Vitaly
dc.contributor.author Rosell Ortiz, Fernando
dc.contributor.author Ostojic, Miodrag
dc.contributor.author Welsh, Robert C.
dc.contributor.author Carvalho, Antonio C. [UNIFESP]
dc.contributor.author Nanas, John
dc.contributor.author Arntz, Hans-Richard
dc.contributor.author Halvorsen, Sigrun
dc.contributor.author Huber, Kurt
dc.contributor.author Grajek, Stefan
dc.contributor.author Fresco, Claudio
dc.contributor.author Bluhmki, Erich
dc.contributor.author Regelin, Anne
dc.contributor.author Vandenberghe, Katleen
dc.contributor.author Bogaerts, Kris
dc.contributor.author Van de Werf, Frans
dc.contributor.author STREAM Investigative Team
dc.date.accessioned 2016-01-24T14:31:34Z
dc.date.available 2016-01-24T14:31:34Z
dc.date.issued 2013-04-11
dc.identifier http://dx.doi.org/10.1056/NEJMoa1301092
dc.identifier.citation New England Journal of Medicine. Waltham: Massachusetts Medical Soc, v. 368, n. 15, p. 1379-1387, 2013.
dc.identifier.issn 0028-4793
dc.identifier.uri http://repositorio.unifesp.br/handle/11600/36203
dc.description.abstract 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.) en
dc.description.sponsorship Boehringer Ingelheim
dc.description.sponsorship Eli Lilly
dc.description.sponsorship Merck
dc.description.sponsorship Roche
dc.description.sponsorship Daiichi Sankyo
dc.description.sponsorship Medicines Company
dc.description.sponsorship AstraZeneca
dc.description.sponsorship Sanofi
dc.description.sponsorship Bayer
dc.description.sponsorship Schering-Plough
dc.description.sponsorship Sanofi-Aventis
dc.description.sponsorship Bristol-Myers Squibb
dc.description.sponsorship Abbott
dc.description.sponsorship Medtronic
dc.description.sponsorship Edwards Lifesciences
dc.description.sponsorship Servier
dc.description.sponsorship Pfizer
dc.format.extent 1379-1387
dc.language.iso eng
dc.publisher Massachusetts Medical Soc
dc.relation.ispartof New England Journal of Medicine
dc.rights Acesso restrito
dc.title Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction en
dc.type Artigo
dc.contributor.institution Univ Alberta
dc.contributor.institution Univ Hosp Leicester Trust
dc.contributor.institution Univ Nottingham
dc.contributor.institution Lille Univ Hosp
dc.contributor.institution Boehringer Ingelheim GmbH & Co KG
dc.contributor.institution Ctr Hosp Versailles
dc.contributor.institution Mobile Intens Care Unit
dc.contributor.institution First Moscow State Med Univ
dc.contributor.institution Empresa Publ Emergencias Sanitarias
dc.contributor.institution Univ Belgrade
dc.contributor.institution Universidade Federal de São Paulo (UNIFESP)
dc.contributor.institution Univ Athens
dc.contributor.institution Benjamin Franklin Med Ctr
dc.contributor.institution Univ Oslo
dc.contributor.institution Wilhelminenhosp
dc.contributor.institution Poznan Univ Med Sci
dc.contributor.institution Azienda Osped Univ Udine
dc.contributor.institution Katholieke Univ Leuven
dc.contributor.institution Univ Hasselt
dc.description.affiliation Univ Alberta, Canadian Virtual Coordinating Ctr Global Collabor, Edmonton, AB, Canada
dc.description.affiliation Univ Alberta, Mazankowski Alberta Heart Inst, Edmonton, AB, Canada
dc.description.affiliation Univ Hosp Leicester Trust, Leicester Cardiovasc Biomed Res Unit, Natl Inst Hlth Res, Leicester, Leics, England
dc.description.affiliation Univ Nottingham, Dept Cardiovasc Med, Nottingham NG7 2RD, England
dc.description.affiliation Lille Univ Hosp, Emergency Dept, Lille, France
dc.description.affiliation Lille Univ Hosp, SAMU, Lille, France
dc.description.affiliation Boehringer Ingelheim GmbH & Co KG, Reims, France
dc.description.affiliation Ctr Hosp Versailles, SAMU 78, Versailles, France
dc.description.affiliation Mobile Intens Care Unit, Versailles, France
dc.description.affiliation First Moscow State Med Univ, Dept Internal Dis, Moscow, Russia
dc.description.affiliation Empresa Publ Emergencias Sanitarias, Almeria, Spain
dc.description.affiliation Univ Belgrade, Sch Med, Belgrade, Serbia
dc.description.affiliation Universidade Federal de São Paulo, Dept Med, Div Cardiol, São Paulo, Brazil
dc.description.affiliation Univ Athens, Dept Cardiol 3, GR-10679 Athens, Greece
dc.description.affiliation Benjamin Franklin Med Ctr, Charite, Berlin, Germany
dc.description.affiliation Univ Oslo, Ulleval Hosp, Dept Cardiol, Oslo, Norway
dc.description.affiliation Wilhelminenhosp, Dept Med Cardiol & Emergency Med 3, Vienna, Austria
dc.description.affiliation Poznan Univ Med Sci, Dept Cardiol, Poznan, Poland
dc.description.affiliation Azienda Osped Univ Udine, Dept Cardiothorac Sci, Udine, Italy
dc.description.affiliation Boehringer Ingelheim GmbH & Co KG, Biberach, Germany
dc.description.affiliation Boehringer Ingelheim GmbH & Co KG, Basel, Switzerland
dc.description.affiliation Katholieke Univ Leuven, Dept Cardiovasc Sci, B-3000 Louvain, Belgium
dc.description.affiliation Katholieke Univ Leuven, Interuniv Inst Biostat & Stat Bioinformat, B-3000 Louvain, Belgium
dc.description.affiliation Univ Hasselt, Hasselt, Belgium
dc.description.affiliationUnifesp Universidade Federal de São Paulo, Dept Med, Div Cardiol, São Paulo, Brazil
dc.identifier.doi 10.1056/NEJMoa1301092
dc.description.source Web of Science
dc.identifier.wos WOS:000317333600005



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