. 2017 Mar 23;69(Suppl 1):S63–S97. doi: 10.1016/j.ihj.2017.03.006

Table 12.

Major Trials of PI Strategy.

	Trial	Methods	Conclusion
GRACIA-2⁸¹	Grupo de Analysis de la Cardiopati ‘a Isque’ mica Aguda-2	RCT in 211 STEMI patients, comparing full-dose TNK followed by stenting within 3–12 h of randomization (early routine post fibrinolysis angioplasty; 104 patients) with primary stenting with abciximab within 3 h of randomization (primary angioplasty; 108 patients	PI approach, resulted in better myocardial reperfusion and TIMI 3 flows compared to primary PCI despite performance of a delayed PCI.
TRANSFER-AMI⁸²	Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction	Total of 1100 patients with high-risk STEMI presenting to non-PCI centres randomized to a PI strategy (transfer for routine PCI within 6 h of fibrinolysis) or to standard treatment after fibrinolysis.	The benefits of PI strategy were seen to exceed those of standard treatment.
FAST-MI⁸³	French Registry on Acute ST-Elevation Myocardial Infarction	Real world and follow-up data up to 1 year of 1714 patients.	PI strategy yields early and 1-year survival rates that are comparable to those of primary PCI.
WEST⁸⁴	Which Early ST-elevation myocardial infarction Therapy	Open-label, randomized, feasibility study of 304 STEMI patients comparing the effect of TNK and usual care (Group A), TNK and mandatory invasive study in 24 h, including rescue PCI for reperfusion failure (Group B) and primary PCI with 300 mg loading-dose of clopidogrel (Group C).	Pharmacologic regimen rapidly delivered, coupled with routine coronary intervention within 24 h of initial treatment, may not be different from timely expert PCI.
NORDISTEMI⁸⁵	Norwegian Study of District Treatment of STEMI	266 patients with STEMI living in rural areas with more than 90-min transfer delays to PCI were treated with TNK, and randomized to immediate transfer for PCI or to standard management in the local hospitals with early transfer, only if indicated for rescue or clinical deterioration	Immediate transfer for PCI reduced the rate of death, reinfarction, or stroke at 12 months in patients with STEMI, treated with thrombolysis.
CARESS-in-AMI⁸⁶	Immediate angioplasty versus standard therapy with rescue angioplasty after thrombolysis in the Combined AbciximabREteplase Stent Study in Acute Myocardial Infarction	Open, prospective, randomised, multicentre trial of 600 patients treated with half-dose reteplase and abciximab.	Immediate transfer for PCI improves outcome in high-risk patients with STEMI when compared to transfer only if indicated.
STREAM⁸⁷	Fibrinolysis or Primary PCI in ST-Segment Elevation Myocardial Infarction	1892 patients with STEMI were randomized to either PI group or primary PCI group	PI strategy resulted in effective reperfusion in patients with STEMI who presented within 3 h after symptom onset.