Table 1.
Summary of recent randomised controlled trials on pre-hospital therapeutic strategies before PCI in patients with acute myocardial infarction
| Therapy | Study | No. of patients | Primary endpoints | Outcome |
|---|---|---|---|---|
| Abciximab | Pels et al. (2008) [34] | 101 |
STR before PCI Initial TIMI 3 flow in IRA |
No improvement in initial TIMI flow or STR |
| Petronio et al. (2012) [35] | 110 | Infarct size (LGE-MRI) | No reduction in infarct size | |
| Ohlmann et al. (2012) [36] | 256 | Complete STR (>70%) after PCI | No improvement in STR | |
| Tirofiban | Van ’t Hof (2008) [37] | 984 | Mean residual STD after PCI | Improvement in STR |
| El Khoury et al. (2010) [38] | 320 | Initial TIMI 2/3 flow in IRA | No improvement in initial TIMI 2/3 flow | |
| Clopidogrel | Zeymer et al. (2012) [39] | 337 | Initial TIMI 2/3 flow in IRA | No improvement in initial TIMI 2/3 flow |
| Ticagrelor | Montalescot et al. (2014) [40] | 1862 |
Initial TIMI flow STR before PCI |
No improvement in initial TIMI flow or STR |
| Bivalirudin | Steg et al. (2013) [41]a | 2218 | Combined endpoint of death or major bleeding (30 days) | Reduced composite endpoint (driven by less major bleeding), increased stent thrombosis |
| Tenecteplase | Armstrong (2006) [42] | 304 | Combined endpoint of death, re-infarction, refractory ischaemia, congestive heart failure, cardiogenic shock, and major ventricular arrhythmia | No difference in combined endpoint compared with PCI alone |
| Thiele et al. (2011) [43] | 162 | Infarct size (LGE-MRI) | No reduction in infarct size | |
| Metoprolol | Ibanez et al. (2013) [44]a | 270 | Infarct size (LGE-MRI) | Reduction in infarct size |
| Roolvink et al. (2016) [8] | 684 | Infarct size (LGE-MRI) | No reduction in infarct size | |
| Oxygen | Stub et al. (2015) [45] | 441 | Infarct size (enzymes) | Increase in infarct size |
| Khoshnood et al. (2018) [46] | 95 | Myocardial salvage index (LGE-MRI) | No improvement of myocardial salvage | |
| Ischaemic conditioning | Hausenloy et al. (2019) [47]a | 5115 | Combined endpoint of cardiac death and HF hospitalisation | No improvement of clinical outcomes |
| Hypothermia | Testori et al. (2019) [48] | 101 | Myocardial salvage index (LGE-MRI) | No improvement of myocardial salvage |
LGE-MRI late gadolinium enhancement—magnetic resonance imaging, TIMI thrombolysis in myocardial infarction, STR ST-segment resolution, STD ST-segment deviation, PCI percutaneous coronary intervention, IRA infarct-related artery, MACE major adverse cardiac events, HF heart failure
aSome patients received treatment during transfer to the PCI centre, others received the treatment upon arrival in the hospital