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NORDISTEMI study: Immediate angioplasty versus ischemia-guided management after thrombolysis for ST-segment elevation myocardial infarction in areas with very long transfers

Hot Line II

Acute Coronary Syndromes (ACS)


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Presenter | see Discussant report

Sigrun Halvorsen, FESC (Norway)

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List of Authors:
Ellen Bøhmer, Pavel Hoffmann, Michael Abdelnoor, Harald Arnesen, Sigrun Halvorsen

Abstract:

Purpose:

Thrombolysis remains the treatment of choice in ST-segment elevation myocardial infarction (STEMI) when primary PCI cannot be performed within 90-120 min. The efficacy and safety of early PCI after thrombolysis is still unclear. The aim of this study was to compare a strategy of immediate transfer for PCI after thrombolysis to an ischemia-guided approach, in patients with very long transfer distances.

Methods:
266 patients with acute STEMI of < 6 h duration, living in rural areas in Norway with 100 - 400 km transfer distances to PCI were treated with full-dose tenecteplase, aspirin, enoxaparin and clopidogrel. Patients were randomized to immediate transfer for PCI, or to conservative management in the community hospitals with urgent transfer only if rescue indication or clinical deterioration. The primary outcome was a composite of death, reinfarction, stroke or new ischemia within 12 months, and analysis was by intention to treat.

Results:
The primary endpoint at 12 months was reached in 28 patients (21 %) in the early invasive group compared with 36 (27 %) in the conservative group (hazard ratio 0.72, 95% CI 0.44-1.18, p=0.19). The composite of death, reinfarction or stroke at 12 months was significantly reduced in the early invasive compared to the conservative group (6.0% versus 16%, hazard ratio 0.36, 95% CI 0.16-0.81, p=0.01). No significant differences in bleeding or infarct size were observed, and transport complications were few.

Conclusions:
Immediate transfer for PCI after thrombolysis did not improve the primary outcome significantly, but reduced the rate of death, reinfarction or stroke within 12 months compared to conservative treatment.

 

 Discussant | see Presenter abstract

 Freek Verheugt 

Freek Verheugt, FESC (Netherlands)










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Report:

References


1844-1845

SessionTitle:

Immediate angioplasty versus ischemia-guided management after thrombolysis for ST-segment elevation myocardial infarction in areas with very long transfers: The NORDISTEMI study

Notes to editor


This congress report accompanies a presentation given at the ESC Congress 2009. Written by the author himself/herself, this report does not necessarily reflect the opinion of the European Society of Cardiology.

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.