Author + information
- Amit Vora,
- DaJuanicia Holmes,
- Ivan Rokos,
- Matthew Roe,
- Christopher Granger,
- William French,
- Elliott Antman,
- Timothy Henry,
- Laine Thomas,
- Eric Bates and
- Tracy Wang
Guidelines recommend fibrinolysis for STEMI patients who cannot achieve primary percutaneous coronary intervention (pPCI) within 120 minutes of first contact. Yet, current use of fibrinolytic therapy among contemporary STEMI patients in the United States is unclear.
From ACTION Registry-GWTG between 7/2008-3/2012, we identified 12,852 fibrinolytic-eligible STEMI patients first evaluated at a non-pPCI hospital then transferred to a pPCI center 30 −120 min drive time away (5th percentile of fibrinolysis and 95% percentile of pPCI respectively).
A total of 5,254 patients (41%) received pretransfer fibrinolysis and 7,598 patients underwent pPCI. Patients receiving fibrinolysis had similar clinical characteristics compared with those receiving pPCI (Table). Referral hospitals that used fibrinolysis had longer drive times to PCI centers than those that transferred for pPCI. Guideline-recommended time goals were achieved in <50% of patients reperfused with either strategy. After fibrinolysis, 42% required rescue PCI and 27% more underwent subsequent PCI at a median of 19 hours (IQR 8–34) later. There was no significant difference in associated in-hospital mortality between fibrinolysis and pPCI (3.8 vs. 3.9%, adjusted OR 1.15, 95%CI 0.94–1.40).
Fibrinolysis remains a viable reperfusion strategy for eligible patients in the US. However, timeliness of reperfusion regardless of strategy remains a target for improvement for transferred STEMI patients.
|Fibrinolysis (n=5254)||Primary PCI (n = 7598)||p-value|
|Age, median (%≥65 years)||59 (32.2%)||59 (35.4%)||0.023 (<0.001)|
|Prior heart failure||3.7%||4.2%||0.16|
|CrCl, median (IQR), ml/min||90 (68–116)||91 (67–119)||0.03|
|ACTION mortality risk score, median (IQR)||31 (26–37)||32 (27–38)||0.002|
|Door to needle, median (IQR)||34 (23–52)||–||–|
|Door to balloon, median (IQR)||–||129 (106–170)||–|
|Referral hospital bed size, median (IQR)||89 (49–142)||91 (47–142)||0.41|
|Door-in-door-out time, median (IQR)||85 (63–116)||60 (42–88)||<0.001|
|Drive time to pPCI hospital, median (IQR)||64 (49–84)||50 (40–65)||<0.001|
Moderated Poster Contributions
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: ACS Therapy
Abstract Category: 3. Acute Coronary Syndromes: Therapy
Presentation Number: 1255M-173
- 2013 American College of Cardiology Foundation