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(Circulation. 2008;118:268-276.)
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Interventional Cardiology

Comparison of Thrombolysis Followed by Broad Use of Percutaneous Coronary Intervention With Primary Percutaneous Coronary Intervention for ST-Segment–Elevation Acute Myocardial Infarction

Data From the French Registry on Acute ST-Elevation Myocardial Infarction (FAST-MI)

Nicolas Danchin, MD; Pierre Coste, MD; Jean Ferrières, MD; Philippe-Gabriel Steg, MD; Yves Cottin, MD; Didier Blanchard, MD; Loïc Belle, MD; Bernard Ritz, MD; Gilbert Kirkorian, MD; Michael Angioi, MD; Philippe Sans, MD; Bernard Charbonnier, MD; Hélène Eltchaninoff, MD; Pascal Guéret, MD; Khalife Khalife, MD; Philippe Asseman, MD; Jacques Puel, MD; Patrick Goldstein, MD; Jean-Pierre Cambou, MD; Tabassome Simon, MD, for the FAST-MI Investigators^*

From Hôpital Européen Georges Pompidou (N.D.), Assistance publique des hôpitaux de Paris, and Université Paris 5, Paris, France; Centre Hospitalier Universitaire Haut Levesque (P.C.), Bordeaux-Pessac, France; Centre Hospitalier Universitaire Rangueil (J.F., J.P.), Toulouse, France; INSERM U-698 et Centre Hospitalier Bichat-Claude Bernard (P.-G.S.), Paris, France; Centre Hospitalier Universitaire Dijon (Y.C.), Dijon, France; Clinique St Gatien (D.B.), Tours, France; Centre Hospitalier d’Annecy (L.B.), Annecy, France; Centre Hospitalier St Joseph et St Luc (B.R.), Lyon, France; Hôpital Cardio-pneumologique (G.K.), Lyon, France; Centre Hospitalier Universitaire Nancy-Brabois (M.A.), Vandoeuvre-lès-Nancy, France; Hôpital Font Pré (P.S.), Toulon, France; Centre Hospitalier Universitaire Tours (B.C.), Tours, France; Centre Hospitalier Universitaire Rouen (H.E.), Rouen, France; Hôpital Henri Mondor (P. Guéret), Créteil, France; Hôpital Bon Secours (K.K.), Metz, France; Hôpital cardiologique (P.A.), Lille, France; Service d’Aide Médicale Urgente (P. Goldstein), Centre Hospitalier Universitaire Lille, Lille, France; Société Française de Cardiologie (J.-P.C.), Paris, France; and Hôpital St Antoine (T.S.), Assistance publique des hôpitaux de Paris, Unité de Recherche Clinique de L’Est Parisien, Université Pierre et Marie Curie Paris 6, Paris, France.

Correspondence to Nicolas Danchin, MD, Division of Coronary Artery Disease and Intensive Cardiac Care, Hôpital Européen Georges Pompidou, Assistance-Publique des Hôpitaux de Paris and Faculté René Descartes, Université Paris 5, 20 rue Leblanc, 75015 Paris, France. E-mail nicolas.danchin{at}egp.aphp.fr

Received December 27, 2007; accepted May 1, 2008.

Background— Intravenous thrombolysis remains a widely used treatment for ST-elevation myocardial infarction; however, it carries a higher risk of reinfarction than primary PCI (PPCI). There are few data comparing PPCI with thrombolysis followed by routine angiography and PCI. The purpose of the present study was to assess contemporary outcomes in ST-elevation myocardial infarction patients, with specific emphasis on comparing a pharmacoinvasive strategy (thrombolysis followed by routine angiography) with PPCI.

Methods and Results— This nationwide registry in France included 223 centers and 1714 patients over a 1-month period at the end of 2005, with 1-year follow-up. Sixty percent of the patients underwent reperfusion therapy, 33% with PPCI and 29% with intravenous thrombolysis (18% prehospital). At baseline, the Global Registry of Acute Coronary Events score was similar in thrombolysis and PPCI patients. Time to initiation of reperfusion therapy was significantly shorter in thrombolysis than in PPCI (median 130 versus 300 minutes). After thrombolysis, 96% of patients had coronary angiography, and 84% had subsequent PCI (58% within 24 hours). In-hospital mortality was 4.3% for thrombolysis and 5.0% for PPCI. In patients with thrombolysis, 30-day mortality was 9.2% when PCI was not used and 3.9% when PCI was subsequently performed (4.0% if PCI was performed in the same hospital and 3.3% if performed after transfer to another facility). One-year survival was 94% for thrombolysis and 92% for PPCI (P=0.31). After propensity score matching, 1-year survival was 94% and 93%, respectively.

Conclusions— When used early after the onset of symptoms, a pharmacoinvasive strategy that combines thrombolysis with a liberal use of PCI yields early and 1-year survival rates that are comparable to those of PPCI.

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