The Atlantic C-PORT Trial: A Community-Hospital–Based, Prospective, Randomized Trial Comparing Thrombolytic Therapy With Primary
453 patients from 11 community hospitals without on-site cardiac surgery were randomly assigned to receive either thrombolytic therapy (TT) or primary percutaneous coronary intervention (PPCI) for treatment of acute myocardial infarction (AMI). The primary outcome was the incidence of the composite adverse event (CAE) endpoint of death, recurrent myocardial infarction (MI) or stroke 6 months after the index MI. The time between emergency room (ER) arrival and first balloon inflation was 107 ± 34 minutes; and the ER to thrombolytic administration time was 53 ± 35 minutes. In an intention-to-treat analysis, at 6 weeks, patients treated with PPCI had a 42% reduction in the incidence of CAE compared with TT (15.4 % vs 8.8 %, p=0.03). At 6 months, the CAE was lower with PPCI than after TT by 31 % (15.4 % vs 10.6%, P=0.13). In a treatment-received analysis, patients treated with PPCI had significantly improved outcomes at 6 weeks and 6 months compared with patients treated with TT (15.7% vs. 8.1% at 6 wk; 16.9% vs. 10.4% at 6 months, both p<0.05). Women benefited from PPCI with nearly 50% reductions in the CAE outcome at 6 weeks and 6 months compared with TT (27.3% vs 10.7% at 6 wks, p<0.02; 27.3% vs 13.8 % at 6 m, p=0.058). Patients over age 65 also benefited from PPCI compared with TT with 40% reductions in the CAE rate (25.9% vs 13.0% at 6 wk, p<0.02; 27.8% vs 15.6%, p=0.01). We also noted that outcomes at low volume centers performing fewer than 1 PPCI per month were no better with PPCI than with TT; while outcomes at relatively high volume centers performing an average of 2 PPCI’s per month had clearly improved outcomes with PPCI over TT. We conclude that PPCI is at least as good, and in some circumstances is superior to TT for treatment of AMI in community hospitals without on-site cardiac surgery. Access to PPCI can be extended to some, but not all hospitals, without on-site cardiac surgery if the center is committed to the necessary program development and monitoring process, performs a high volume and has PPCI availability 24/7.
- Copyright © 2000 by American Heart Association