EHJ: Primary PCI, pre-hospital lysis have similar 5-year mortality outcomes

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Primary PCI and a policy of pre-hospital lysis followed by transfer to an interventional center have similar mortality rates at five years, which is consistent with the 30-day outcomes, according to the CAPTIM trial in the July issue of the European Heart Journal.

The CAPTIM (Comparison of primary Angioplasty and Pre-hospiTal fibrinolysis In acute MI) study found no evidence that a strategy of primary angioplasty was superior in terms of 30-day outcomes to a strategy of pre-hospital fibrinolysis with transfer to an interventional facility in patients managed early at the acute phase of an acute MI.

Eric Bonnefoy, MD, from the Univeristé Lyon, Hôpital Cardio-Vasculaire et Pneumologique, Hospices Civils de Lyon in Lyon Cedex, France, and colleagues conducted the present analysis, designed to compare both strategies at five years.

According to the researchers, the CAPTIM study included 840 patients managed in a pre-hospital setting within six hours of a STEMI. They randomized patients to either a primary angioplasty (421) or a pre-hospital fibrinolysis with immediate transfer to a center with interventional facilities (419). Long-term follow-up was obtained in blinded fashion from 795 patients.

Using an intent-to-treat analysis, the investigators said that the all-cause mortality at five years was 9.7 percent in the pre-hospital fibrinolysis group, compared with 12.6 percent in the primary angioplasty group.

For patients included within two hours, five-year mortality was 5.8 percent in the pre-hospital fibrinolysis group when compared with 11.1 percent in the primary angioplasty group, whereas it was, respectively, 14.5 and 14.4 percent in patients included after two hours, the authors reported.

However, Bonnefoy and colleagues found that for patients treated within two hours of symptom onset, five-year mortality was lower with pre-hospital lysis.