Abstract 122: A Coordinated Pre-Hospital Initiated Thrombolytic Strategy Coupled With Urgent PCI Dramatically Reduces Time to Treatment for STEMI Patients.
Background: For STEMI patients treatment in the first 2 hours of ischemia is critical in determining outcome. We tested the hypothesis that a pre-hospital initiated pharmacologic reperfusion coupled with emergent PCI (Fibrinolytic Acceleration of STEMI Treatment (FAST)-PCI) would significantly increase the proportion of patients receiving reperfusion therapy within 2 hours of symptom onset, increasing the incidence of aborted MI and decreasing total CK.
Methods: Pre-hospital STEMI ECGs were transmitted for confirmation. Patients were randomized to: full dose pre-hospital reteplase (Group A) vs. 1/2 of pre-hospital reteplase followed by urgent PCI (Group B). Group C were fibrinolytic ineligible and treated with PCI. Aborted MI was defined as STEMI ECG; 2x rise in upper limit of normal, angiographic lesion consistent with injury pattern on ECG
Results: 314 patients enrolled. 278 treated with pre-hospital fibrinolysis (37 full dose and 241 ½-dose). 36 fibrinolytic ineligible patients were enrolled. Symptom to fibrinolysis mean time to treatment 121 min SD 98 was significantly shorter than symptom to PCI 183min SD 98 p <0.001. Patients who received pre-hospital reteplase were more likely to have reperfusion therapy initiated within 90 (49% vs. 3% p <0.0001) and 120 (74% vs. 17% p. <0.0001) minutes compared to symptom to PCI time. D2B times averaged 59 minutes with 95% CI 53.75 to 64.10. Incidence of aborted MI (17.32% vs. 11.01%) while lower did not reach statistical significance (p 0.1839). Peak CK was notably lower in the < 120 treatment group 1765.71 SD1617.06 vs. 2342.89 SD 2398.16 p 0.0269
Conclusions: This coordinated pre-hospital reperfusion strategy produced a dramatic reduction in symptom onset to therapy. Even with ultra short D2B times, without a pre-hospital reperfusion strategy the vast majority of STEMI patients will still have >120 minutes of ischemia. A FAST-PCI can significantly increase the number of patients treated in the first 120 minutes of ischemia.
- © 2010 by American Heart Association, Inc.