| Titre : | Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction : a randomised study. Commentary. (2002) |
| Auteurs : | Eric BONNEFOY ; Eric BOULLENGER ; Jean Cassagnes ; Simon Cattan ; Francois DISSAIT ; Pierre-Yves DUBIEN ; Jean-Michel LACROUTE ; Frédéric LAPOSTOLLE ; Alain LEIZOROVICZ ; Jacques MACHECOURT ; Eugène-P MCFADDEN ; Gabriel Steg ; Gregg-W STONE ; Paul TOUBOUL ; Coronary Care Unit. Hôpital Louis Pradel. Hospices Civlis de Lyon. Lyon. FRA |
| Type de document : | Article |
| Dans : | Lancet (The) (vol. 360, n° 9336, 2002) |
| Pagination : | 814-829 (8p.) |
| Langues: | Anglais |
| Mots-clés : | Infarctus ; Myocarde ; Etude comparée ; Thérapeutique médicamenteuse ; Thérapeutique ; Homme ; Epidémiologie ; France ; Europe ; Appareil circulatoire [pathologie] ; Cardiopathie coronaire ; Myocarde [pathologie] |
| Résumé : | [BDSP. Notice produite par INIST-CNRS ne05R0xe. Diffusion soumise à autorisation]. Background Although both prehospital fibrinolysis and primary angioplasty provide a clinical benefit over in-hospital fibrinolysis in acute myocardial infarction, they have not been directly compared. Our aim was to find out whether primary angioplasty was better than prehospital fibrinolysis. Methods We did a randomised multicentre trial of 840 patients (of 1200 planned) who presented within 6 h of acute myocardial infarction with ST-segment elevation, initially managed by mobile emergency-care units. We assigned patients to prehospital fibrinolysis (n=419) with accelerated alteplase or primary angioplasty (n=421), and transferred all to a centre with access to emergency angioplasty. Our primary endpoint was a composite of death, non-fatal reinfarction, and non-fatal disabling stroke at 30 days. Analyses were by intention to treat. Findings The median delay between onset of symptoms and treatment was 130 min in the prehospital-fibrinolysis group and 190 min (time to first balloon inflation) in the primary-angioplasty group. Rescue angioplasty was done in 26% of the patients in the fibrinolysis group. The rate of the primary endpoint was 8.2% (34 patients) in the prehospital-fibrinolysis group and 6.2% (26 patients) in the primary-angioplasty group (risk difference 1.96,95% Cl - 1.53 to 5.46). 16 (3.8%) patients assigned prehospital fibrinolysis and 20 (4.8%) assigned primary angioplasty died (p=0.61). Interpretation A strategy of primary angioplasty was not better than a strategy of prehospital fibrinolysis (with transfer to an interventional facility for possible rescue angioplasty) in patients presenting with early myocardial infarction. |
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