In the CARESS study, which took place in Poland, Italy and France, 600 MI patients were randomised at the time of admission either to receive urgent transfer to ancillary PCI after thrombolysis, or to receive medical treatment with referral for PCI only if they experienced persistent ST elevation after 90 minutes of treatment, chest pain or haemodynamic compromise. Overall, 35.7% of those who received thrombolysis alone were subsequently referred for PCI. Results at 30 days showed that 4.1% of patients in the group who had immediate transfer for PCI experienced the combined end-point of death and MI complications, compared to 11.1 % in the group who only had thrombolytic therapy (p<0.001).
Additional findings showed that the average length of hospital stay was seven days in the facilitated PCI group and nine days in the thrombolysis-alone group (p<0.001).
“The study suggests PCI guidelines need to be changed so that all patients are referred for PCI,” principal investigator Carlo di Mario (Imperial College, London, UK) said at the Hot Line Session. Discussant Freek Verheugt (Nijmegen, NL) said that, taken together with the earlier GRACIA-1, SIAM-3 and CAPITAL-MI trials, CARESS confirms early PCI should now routinely follow thrombolytic therapy. “But randomised trials are needed to determine whether PCI works best within 2.5 hours - as in CARESS - or if patients can wait 17 hours after thrombolytic therapy - as in GRACIA,” he said.
Discussant Freek Verheugt: "The take home message from these two important trials is that facilitation of primary PCI for STEMI now seems dead, but PCI after thrombolysis lives on and should be considered mandatory."