Titre :
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Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction : a randomised study. Commentary. (2002)
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Auteurs :
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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
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Type de document :
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Article
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Dans :
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Lancet (The) (vol. 360, n° 9336, 2002)
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Pagination :
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814-829 (8p.)
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Langues:
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Anglais
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Mots-clés :
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Infarctus
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Myocarde
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Etude comparée
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Thérapeutique médicamenteuse
;
Thérapeutique
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Homme
;
Epidémiologie
;
France
;
Europe
;
Appareil circulatoire [pathologie]
;
Cardiopathie coronaire
;
Myocarde [pathologie]
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Résumé :
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[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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