PMID- 22041553
OWN - NLM
STAT- MEDLINE
DCOM- 20120730
LR  - 20181201
IS  - 1522-9645 (Electronic)
IS  - 0195-668X (Linking)
VI  - 33
IP  - 10
DP  - 2012 May
TI  - Safety and efficacy of a pharmaco-invasive reperfusion strategy in rural 
      ST-elevation myocardial infarction patients with expected delays due to 
      long-distance transfers.
PG  - 1232-40
LID - 10.1093/eurheartj/ehr403 [doi]
AB  - AIMS: To determine the safety and efficacy of a pharmaco-invasive reperfusion 
      strategy utilizing half-dose fibrinolysis combined with transfer for immediate 
      percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction 
      (STEMI) patients presenting to remote rural hospitals. Primary PCI is preferred 
      for STEMI if performed in a timely manner. However, <20% of STEMI patients 
      transferred for PCI in the USA have door-to-balloon times <2 h. METHODS AND 
      RESULTS: Prospective data from the Level 1 MI programme were analysed. All STEMI 
      patients presenting to the Minneapolis Heart Institute or 31 referral hospitals 
      received aspirin, clopidogrel, and unfractionated heparin (UFH) at the presenting 
      hospital and those presenting to hospitals >/=60 miles away also received half-dose 
      fibrinolytic with transfer for immediate PCI. From April 2003 through December 
      2009, we enrolled 2634 consecutive STEMI patients in the Level 1 MI database 
      including 660 transferred from remote hospitals utilizing pharmaco-invasive 
      therapy and 600 patients who presented directly to the PCI centre. There were no 
      significant differences in 30-day mortality (5.5 vs. 5.6%; P= 0.94), stroke (1.1 
      vs. 1.3%; P= 0.66) or major bleeding (1.5 vs. 1.8%; P= 0.65), or 
      re-infarction/ischaemia (1.2 vs. 2.5%; P= 0.088) in patients receiving a 
      pharmaco-invasive strategy compared with patients presenting directly to the PCI 
      centre, despite a significantly longer door-to-balloon time. CONCLUSION: Within a 
      regional STEMI system of care, half-dose fibrinolysis combined with immediate 
      transfer for PCI may be a safe and effective option for STEMI patients with 
      expected delays due to long-distance transfer.
FAU - Larson, David M
AU  - Larson DM
AD  - Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, 920 East 
      28th Street, Minneapolis, MN 55407, USA. stephan.schirmer@uks.eu
FAU - Duval, Sue
AU  - Duval S
FAU - Sharkey, Scott W
AU  - Sharkey SW
FAU - Garberich, Ross F
AU  - Garberich RF
FAU - Madison, James D
AU  - Madison JD
FAU - Stokman, Peter J
AU  - Stokman PJ
FAU - Dirks, Timothy G
AU  - Dirks TG
FAU - Westin, Robert K
AU  - Westin RK
FAU - Harris, James L
AU  - Harris JL
FAU - Henry, Timothy D
AU  - Henry TD
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20111031
PL  - England
TA  - Eur Heart J
JT  - European heart journal
JID - 8006263
RN  - 0 (Adrenergic beta-Antagonists)
RN  - 0 (Fibrinolytic Agents)
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - EC 3.4.21.68 (Tissue Plasminogen Activator)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
RN  - WGD229O42W (Tenecteplase)
SB  - IM
CIN - Eur Heart J. 2012 May;33(10):1184-6. PMID: 22120752
MH  - Adrenergic beta-Antagonists/therapeutic use
MH  - Aged
MH  - Angioplasty, Balloon, Coronary/*methods
MH  - Aspirin/therapeutic use
MH  - Clopidogrel
MH  - Emergency Treatment
MH  - Female
MH  - Fibrinolytic Agents/*therapeutic use
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/*therapy
MH  - Myocardial Reperfusion/*methods
MH  - *Patient Transfer
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Prospective Studies
MH  - Recurrence
MH  - Rural Health
MH  - Tenecteplase
MH  - Ticlopidine/analogs & derivatives/therapeutic use
MH  - Tissue Plasminogen Activator/*therapeutic use
MH  - Treatment Outcome
EDAT- 2011/11/02 06:00
MHDA- 2012/07/31 06:00
CRDT- 2011/11/02 06:00
PHST- 2011/11/02 06:00 [entrez]
PHST- 2011/11/02 06:00 [pubmed]
PHST- 2012/07/31 06:00 [medline]
AID - ehr403 [pii]
AID - 10.1093/eurheartj/ehr403 [doi]
PST - ppublish
SO  - Eur Heart J. 2012 May;33(10):1232-40. doi: 10.1093/eurheartj/ehr403. Epub 2011 
      Oct 31.