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Pre-Hospital Fibrinolysis Followed by Angioplasty or Primary Angioplasty in Acute Myocardial Infarction: The Long-Term Clinical Outcome

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Abstract

Background: Randomized trials comparing primary angioplasty and in-hospital fibrinolysis in acute myocardial infarction (AMI) have shown an advantage for primary angioplasty. The long-term follow-up of pre-hospital fibrinolysis followed by elective or rescue coronary angioplasty versus primary angioplasty is not well established after acute myocardial infarction. This study sought to assess the long-term clinical outcome of patients with AMI having either received pre-hospital fibrinolysis optimized by coronary angioplasty or primary angioplasty.

Methods: We conducted a retrospective analysis involving 318 patients who either underwent primary angioplasty (n = 157) or received pre-hospital fibrinolysis followed by an angioplasty (rescue or elective) (n = 161) within 6 hours of the onset of chest pain.

Results: The groups were similar regarding their baseline characteristics except for the ages. No difference was noted for in-hospital mortality (primary PTCA group: 2.48%, combined group: 2.54%; p = ns) with no increased risk of hemorrhage. The 3-year mortality was not significantly different in the two groups (9.7% vs. 4.9%; p = 0.15). Regarding major adverse cardiac events (29.5% vs. 37.5%; p = 0.23), reintervention (22.5% vs. 23.2%; p = 0.99) or target lesion revascularization (16.1% vs. 14.7%; p = 0.68), the groups were statistically similar.

Conclusion: These data from real-life practice emphasize the safety and similar benefits on the long-term clinical outcome of AMI patients having undergone either pre-hospital fibrinolysis followed by angioplasty or primary angioplasty.

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Authors and Affiliations

  1. Cardiology Department, CHU Rangueil, 1 avenue Jean Poulhès, 31403, Toulouse Cedex, France

    J. Roncalli, F. Brunelle, M. Galinier, D. Carrié, J. Fourcade, M. Elbaz, J. Puel & J.M. Fauvel

  2. Emergency Mobile Unit, SAMU 31, 1 avenue Jean Poulhès, 31403, Toulouse Cedex, France

    J.P. Gaston & S. Charpentier

Authors
  1. J. Roncalli
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  2. F. Brunelle
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  3. M. Galinier
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  4. D. Carrié
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  5. J. Fourcade
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  9. J. Puel
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  10. J.M. Fauvel
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Roncalli, J., Brunelle, F., Galinier, M. et al. Pre-Hospital Fibrinolysis Followed by Angioplasty or Primary Angioplasty in Acute Myocardial Infarction: The Long-Term Clinical Outcome. J Thromb Thrombolysis 15, 181–188 (2003). https://doi.org/10.1023/B:THRO.0000011373.44451.8b

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