BACKGROUND:Primary percutaneous coronary intervention (PCI) performed in large community hospitals without cardiac surgery back-up facilities (off-site) reduces door-to-balloon time compared with emergency transferal to tertiary interventional centers (on-site). The present study was performed to explore whether off-site PCI for acute myocardial infarction results in reduced infarct size. METHODS AND RESULTS: One hundred twenty-eight patients with acute ST-segment elevation myocardial infarction were randomly assigned to undergo primary PCI at the off-site center (n = 68) or to transferal to an on-site center (n = 60). Three days after PCI, (99m)Tc-sestamibi SPECT was performed to estimate infarct size. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94 +/- 54 versus 125 +/- 59 min, respectively, p < 0.01), although symptoms-to-treatment time was only insignificantly reduced (257 +/- 211 versus 286 +/- 146 min, respectively, p = 0.39). Infarct size was comparable between treatment centers (16 +/- 15 versus 14 +/- 12%, respectively p = 0.35). Multivariate analysis revealed that TIMI 0/1 flow grade at initial coronary angiography (OR 3.125, 95% CI 1.17-8.33, p = 0.023), anterior wall localization of the myocardial infarction (OR 3.44, 95% CI 1.38-8.55, p < 0.01), and development of pathological Q-waves (OR 5.07, 95% CI 2.10-12.25, p < 0.01) were independent predictors of an infarct size > 12%. CONCLUSIONS: Off-site PCI reduces door-to-balloon time compared with transferal to a remote on-site interventional center but does not reduce infarct size. Instead, pre-PCI TIMI 0/1 flow, anterior wall infarct localization, and development of Q-waves are more important predictors of infarct size.
RCT Entities:
BACKGROUND: Primary percutaneous coronary intervention (PCI) performed in large community hospitals without cardiac surgery back-up facilities (off-site) reduces door-to-balloon time compared with emergency transferal to tertiary interventional centers (on-site). The present study was performed to explore whether off-site PCI for acute myocardial infarction results in reduced infarct size. METHODS AND RESULTS: One hundred twenty-eight patients with acute ST-segment elevation myocardial infarction were randomly assigned to undergo primary PCI at the off-site center (n = 68) or to transferal to an on-site center (n = 60). Three days after PCI, (99m)Tc-sestamibi SPECT was performed to estimate infarct size. Off-site PCI significantly reduced door-to-balloon time compared with on-site PCI (94 +/- 54 versus 125 +/- 59 min, respectively, p < 0.01), although symptoms-to-treatment time was only insignificantly reduced (257 +/- 211 versus 286 +/- 146 min, respectively, p = 0.39). Infarct size was comparable between treatment centers (16 +/- 15 versus 14 +/- 12%, respectively p = 0.35). Multivariate analysis revealed that TIMI 0/1 flow grade at initial coronary angiography (OR 3.125, 95% CI 1.17-8.33, p = 0.023), anterior wall localization of the myocardial infarction (OR 3.44, 95% CI 1.38-8.55, p < 0.01), and development of pathological Q-waves (OR 5.07, 95% CI 2.10-12.25, p < 0.01) were independent predictors of an infarct size > 12%. CONCLUSIONS: Off-site PCI reduces door-to-balloon time compared with transferal to a remote on-site interventional center but does not reduce infarct size. Instead, pre-PCI TIMI 0/1 flow, anterior wall infarct localization, and development of Q-waves are more important predictors of infarct size.
Authors: Elizabeth H Bradley; Jeph Herrin; Yongfei Wang; Barbara A Barton; Tashonna R Webster; Jennifer A Mattera; Sarah A Roumanis; Jeptha P Curtis; Brahmajee K Nallamothu; David J Magid; Robert L McNamara; Janet Parkosewich; Jerod M Loeb; Harlan M Krumholz Journal: N Engl J Med Date: 2006-11-13 Impact factor: 91.245
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Authors: J H Chesebro; G Knatterud; R Roberts; J Borer; L S Cohen; J Dalen; H T Dodge; C K Francis; D Hillis; P Ludbrook Journal: Circulation Date: 1987-07 Impact factor: 29.690
Authors: James C C Moon; Diego Perez De Arenaza; Andrew G Elkington; Anil K Taneja; Anna S John; Duolao Wang; Rajesh Janardhanan; Roxy Senior; Avijit Lahiri; Philip A Poole-Wilson; Dudley J Pennell Journal: J Am Coll Cardiol Date: 2004-08-04 Impact factor: 24.094
Authors: B R Brodie; T D Stuckey; T C Wall; G Kissling; C J Hansen; D B Muncy; R A Weintraub; T A Kelly Journal: J Am Coll Cardiol Date: 1998-11 Impact factor: 24.094
Authors: P Widimský; T Budesínský; D Vorác; L Groch; M Zelízko; M Aschermann; M Branny; J St'ásek; P Formánek Journal: Eur Heart J Date: 2003-01 Impact factor: 29.983