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. 1999 Oct;82(4):426–431. doi: 10.1136/hrt.82.4.426

Prospective randomised comparison between thrombolysis, rescue PTCA, and primary PTCA in patients with extensive myocardial infarction admitted to a hospital without PTCA facilities: a safety and feasibility study

F Vermeer 1, A Ophuis 1, E Berg 1, L Brunninkhuis 1, C Werter 1, A Boehmer 1, A Lousberg 1, W Dassen 1, F Bar 1
PMCID: PMC1760265  PMID: 10490554

Abstract

OBJECTIVE—To assess the safety and feasibility of acute transport followed by rescue percutaneous transluminal coronary angioplasty (PTCA) or primary PTCA in patients with acute myocardial infarction initially admitted to a hospital without PTCA facilities.
DESIGN—In a multicentre randomised open trial, three regimens of treatment of acute large myocardial infarction were compared for patients admitted to hospitals without angioplasty facilities: thrombolytic treatment with alteplase (75 patients), alteplase followed by transfer to the PTCA centre and (if indicated) rescue PTCA (74 patients), or transfer for primary PTCA (75 patients).
RESULTS—Between 1995 and 1997 224 patients were included. Baseline characteristics were distributed evenly. Transport to the PTCA centre was without severe complications in all patients. Mean (SD) delay from onset of symptoms to randomisation was 130 (75) minutes and from randomisation to angiography 90 (25) minutes. Death or recurrent infarction within 42 days occurred in 12 patients in the thrombolysis group, in 10 patients in the rescue PTCA group, and in six patients in the primary PTCA group. These differences were not significant.
CONCLUSIONS—Acute transfer for rescue PTCA or primary PTCA in patients with extensive myocardial infarction is feasible and safe. Efficacy of rescue PTCA or primary PTCA in this setting will have to be tested in larger series before this approach can be implemented as "routine treatment" for patients with extensive myocardial infarction.


Keywords: myocardial infarction; percutaneous transluminal coronary angioplasty; primary PTCA; rescue PTCA; reperfusion

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Figure 1  .

Figure 1  

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Location of the participating hospitals. All participating centres are located in the Limburg province in the Netherlands; on the west and south side is the border with Belgium, and on the east side is the border with Germany.

Figure 2  .

Figure 2  

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Mean treatment delay (minutes) from onset of chest pain to randomisation, and from randomisation to start of angiography for the rescue PTCA and the primary PTCA group.

Figure 3  .

Figure 3  

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TIMI flow at the beginning of acute angiography, at the end of acute angiography, and at the second angiogram after 24-36 hours, in patients allocated to rescue PTCA and primary PTCA.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Abbottsmith C. W., Topol E. J., George B. S., Stack R. S., Kereiakes D. J., Candela R. J., Anderson L. C., Harrelson-Woodlief S. L., Califf R. M. Fate of patients with acute myocardial infarction with patency of the infarct-related vessel achieved with successful thrombolysis versus rescue angioplasty. J Am Coll Cardiol. 1990 Oct;16(4):770–778. doi: 10.1016/s0735-1097(10)80320-1. [DOI] [PubMed] [Google Scholar]
  2. Bär F. W., Meyer J., Vermeer F., Michels R., Charbonnier B., Haerten K., Spiecker M., Macaya C., Hanssen M., Heras M. Comparison of saruplase and alteplase in acute myocardial infarction. SESAM Study Group. The Study in Europe with Saruplase and Alteplase in Myocardial Infarction. Am J Cardiol. 1997 Mar 15;79(6):727–732. doi: 10.1016/s0002-9149(97)89274-0. [DOI] [PubMed] [Google Scholar]
  3. Bär FW, Ophnis TJ, Frederiks J, de Swart HB, van Ommen VG, de Zwaan C, Vermeer F, Gorgels AP, Wellens HJ. Rescue PTCA Following Failed Thrombolysis and Primary PTCA: A Retrospective Study of Angiographic and Clinical Outcome. J Thromb Thrombolysis. 1997;4(2):281–288. doi: 10.1023/a:1008807321037. [DOI] [PubMed] [Google Scholar]
  4. Califf R. M., Topol E. J., George B. S., Boswick J. M., Lee K. L., Stump D., Dillon J., Abbottsmith C., Candela R. J., Kereiakes D. J. Characteristics and outcome of patients in whom reperfusion with intravenous tissue-type plasminogen activator fails: results of the Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) I trial. Circulation. 1988 May;77(5):1090–1099. doi: 10.1161/01.cir.77.5.1090. [DOI] [PubMed] [Google Scholar]
  5. Califf R. M., Topol E. J., Stack R. S., Ellis S. G., George B. S., Kereiakes D. J., Samaha J. K., Worley S. J., Anderson J. L., Harrelson-Woodlief L. Evaluation of combination thrombolytic therapy and timing of cardiac catheterization in acute myocardial infarction. Results of thrombolysis and angioplasty in myocardial infarction--phase 5 randomized trial. TAMI Study Group. Circulation. 1991 May;83(5):1543–1556. doi: 10.1161/01.cir.83.5.1543. [DOI] [PubMed] [Google Scholar]
  6. De Jaegere P. P., Arnold A. A., Balk A. H., Simoons M. L. Intracranial hemorrhage in association with thrombolytic therapy: incidence and clinical predictive factors. J Am Coll Cardiol. 1992 Feb;19(2):289–294. doi: 10.1016/0735-1097(92)90480-b. [DOI] [PubMed] [Google Scholar]
  7. Ellis S. G., da Silva E. R., Heyndrickx G., Talley J. D., Cernigliaro C., Steg G., Spaulding C., Nobuyoshi M., Erbel R., Vassanelli C. Randomized comparison of rescue angioplasty with conservative management of patients with early failure of thrombolysis for acute anterior myocardial infarction. Circulation. 1994 Nov;90(5):2280–2284. doi: 10.1161/01.cir.90.5.2280. [DOI] [PubMed] [Google Scholar]
  8. Gibbons R. J., Holmes D. R., Reeder G. S., Bailey K. R., Hopfenspirger M. R., Gersh B. J. Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. The Mayo Coronary Care Unit and Catheterization Laboratory Groups. N Engl J Med. 1993 Mar 11;328(10):685–691. doi: 10.1056/NEJM199303113281003. [DOI] [PubMed] [Google Scholar]
  9. Grines C. L., Browne K. F., Marco J., Rothbaum D., Stone G. W., O'Keefe J., Overlie P., Donohue B., Chelliah N., Timmis G. C. A comparison of immediate angioplasty with thrombolytic therapy for acute myocardial infarction. The Primary Angioplasty in Myocardial Infarction Study Group. N Engl J Med. 1993 Mar 11;328(10):673–679. doi: 10.1056/NEJM199303113281001. [DOI] [PubMed] [Google Scholar]
  10. Hartzler G. O., Rutherford B. D., McConahay D. R., Johnson W. L., Jr, McCallister B. D., Gura G. M., Jr, Conn R. C., Crockett J. E. Percutaneous transluminal coronary angioplasty with and without thrombolytic therapy for treatment of acute myocardial infarction. Am Heart J. 1983 Nov;106(5 Pt 1):965–973. doi: 10.1016/0002-8703(83)90639-7. [DOI] [PubMed] [Google Scholar]
  11. Kahn J. K., Rutherford B. D., McConahay D. R., Johnson W. L., Giorgi L. V., Shimshak T. M., Ligon R. W., Hartzler G. O. Catheterization laboratory events and hospital outcome with direct angioplasty for acute myocardial infarction. Circulation. 1990 Dec;82(6):1910–1915. doi: 10.1161/01.cir.82.6.1910. [DOI] [PubMed] [Google Scholar]
  12. O'Keefe J. H., Jr, Rutherford B. D., McConahay D. R., Ligon R. W., Johnson W. L., Jr, Giorgi L. V., Crockett J. E., McCallister B. D., Conn R. D., Gura G. M., Jr Early and late results of coronary angioplasty without antecedent thrombolytic therapy for acute myocardial infarction. Am J Cardiol. 1989 Dec 1;64(19):1221–1230. doi: 10.1016/0002-9149(89)90558-4. [DOI] [PubMed] [Google Scholar]
  13. O'Neill W. W., Weintraub R., Grines C. L., Meany T. B., Brodie B. R., Friedman H. Z., Ramos R. G., Gangadharan V., Levin R. N., Choksi N. A prospective, placebo-controlled, randomized trial of intravenous streptokinase and angioplasty versus lone angioplasty therapy of acute myocardial infarction. Circulation. 1992 Dec;86(6):1710–1717. doi: 10.1161/01.cir.86.6.1710. [DOI] [PubMed] [Google Scholar]
  14. Rothbaum D. A., Linnemeier T. J., Landin R. J., Steinmetz E. F., Hillis J. S., Hallam C. C., Noble R. J., See M. R. Emergency percutaneous transluminal coronary angioplasty in acute myocardial infarction: a 3 year experience. J Am Coll Cardiol. 1987 Aug;10(2):264–272. doi: 10.1016/s0735-1097(87)80006-2. [DOI] [PubMed] [Google Scholar]
  15. Simoons M. L., Serruys P. W., van den Brand M., Res J., Verheugt F. W., Krauss X. H., Remme W. J., Bär F., de Zwaan C., van der Laarse A. Early thrombolysis in acute myocardial infarction: limitation of infarct size and improved survival. J Am Coll Cardiol. 1986 Apr;7(4):717–728. doi: 10.1016/s0735-1097(86)80329-1. [DOI] [PubMed] [Google Scholar]
  16. Zijlstra F., de Boer M. J., Hoorntje J. C., Reiffers S., Reiber J. H., Suryapranata H. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med. 1993 Mar 11;328(10):680–684. doi: 10.1056/NEJM199303113281002. [DOI] [PubMed] [Google Scholar]
  17. Zijlstra F., van 't Hof A. W., Liem A. L., Hoorntje J. C., Suryapranata H., de Boer M. J. Transferring patients for primary angioplasty: a retrospective analysis of 104 selected high risk patients with acute myocardial infarction. Heart. 1997 Oct;78(4):333–336. doi: 10.1136/hrt.78.4.333. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. den Heijer P., Vermeer F., Ambrosioni E., Sadowski Z., López-Sendón J. L., von Essen R., Beaufils P., Thadani U., Adgey J., Pierard L. Evaluation of a weight-adjusted single-bolus plasminogen activator in patients with myocardial infarction: a double-blind, randomized angiographic trial of lanoteplase versus alteplase. Circulation. 1998 Nov 17;98(20):2117–2125. doi: 10.1161/01.cir.98.20.2117. [DOI] [PubMed] [Google Scholar]

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