Randomized comparison of pre-hospital-initiated facilitated percutaneous coronary intervention versus primary percutaneous coronary intervention in acute myocardial infarction very early after symptom onset: the LIPSIA-STEMI trial (Leipzig immediate prehospital facilitated angioplasty in ST-segment myocardial infarction)

Holger Thiele, Ingo Eitel, Claudia Meinberg, Steffen Desch, Anja Leuschner, Dietrich Pfeiffer, Andreas Hartmann, Ulrich Lotze, Wolfgang Strauss, Gerhard Schuler, LIPSIA-STEMI Trial Group, H Thiele, G Schuler, H Thiele, H Thiele, A Eitel, C Meinberg, I Eitel, G Fuernau, S Desch, H Thiele, I Eitel, A Leuschner, H Thiele, I Eitel, A Leuschner, J Zachrau, S Desch, A Hartmann, F Mickley, O Gunkel, D Pfeiffer, N Klein, A Hagendorff, U Lotze, W Strauss, H Thiele, G Schuler, Holger Thiele, Ingo Eitel, Claudia Meinberg, Steffen Desch, Anja Leuschner, Dietrich Pfeiffer, Andreas Hartmann, Ulrich Lotze, Wolfgang Strauss, Gerhard Schuler, LIPSIA-STEMI Trial Group, H Thiele, G Schuler, H Thiele, H Thiele, A Eitel, C Meinberg, I Eitel, G Fuernau, S Desch, H Thiele, I Eitel, A Leuschner, H Thiele, I Eitel, A Leuschner, J Zachrau, S Desch, A Hartmann, F Mickley, O Gunkel, D Pfeiffer, N Klein, A Hagendorff, U Lotze, W Strauss, H Thiele, G Schuler

Abstract

Objectives: This multicenter trial sought to assess the merits of facilitated percutaneous coronary intervention (PCI) versus primary PCI in an ST-segment elevation myocardial infarction (STEMI) network with long transfer distances in patients presenting early after symptom onset.

Background: Facilitated PCI with fibrinolysis might be beneficial in specific high-risk STEMI situations to prevent myocardial necrosis expansion.

Methods: Patients with STEMI (<3 h after symptom onset) were randomized to either pre-hospital-initiated facilitated PCI using tenecteplase (Group A; n = 81) or primary PCI (Group B; n = 81) plus optimal antithrombotic comedication. The primary endpoint was infarct size assessed by delayed-enhancement magnetic resonance imaging. Secondary endpoints were microvascular obstruction and myocardial salvage, early ST-segment resolution, and a composite of death, repeated myocardial infarctions, and congestive heart failure within 30 days.

Results: The median time from symptom onset to randomization was 64 min (interquartile range [IQR]: 42 to 103 min) in Group A versus 55 min in Group B (IQR: 27 to 91 min; p = 0.26). Despite better pre-interventional TIMI (Thrombolysis In Myocardial Infarction) flow in Group A (71% vs. 35% TIMI flow grade 2 or 3; p < 0.001), the infarct size tended to be worse in Group A versus Group B (17.9% of left ventricle [IQR: 8.4% to 35.0%] vs. 13.7% [IQR: 7.5% to 24.0%]; p = 0.10). There was also a strong trend toward more early and late microvascular obstruction, (p = 0.06 and 0.09) and no difference in ST-segment resolution (p = 0.26). The combined clinical endpoint showed a trend toward higher event rates in Group A (19.8% vs. 13.6%; p = 0.13, relative risk: 0.52, 95% confidence interval: 0.23 to 1.18).

Conclusions: In STEMI patients presenting early after symptom onset with relatively long transfer times, a fibrinolytic-based facilitated PCI approach with optimal antiplatelet comedication does not offer a benefit over primary PCI with respect to infarct size and tissue perfusion. ([LIPSIA-STEMI] The Leipzig Immediate Prehospital Facilitated Angioplasty in ST-Segment Myocardial Infarction; NCT00359918).

Copyright © 2011 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Source: PubMed

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