A randomized trial of transfer for primary angioplasty versus on-site thrombolysis in patients with high-risk myocardial infarction

Abstract

Patients with high-risk AMI at hospitals without a catheterization laboratory may have an improved outcome when transferred for primary PTCA versus on-site thrombolysis; however, this will require further study. The marked delay in the transfer process suggests a role for triaging patients directly to specialized heart-attack centers.

G Uidelines for a Ir M Edical D Ispatch

“…For example, recent studies have reinforced arguments in favor of helicopter transport of blunt trauma patients 11,12 and strongly suggested outcomes benefit for interfacility air transport for a subset of patients with acute myocardial infarction. 13 Additionally, the Task Force recognizes that air transport modalities should play a cooperative role in systemwide responses to disasters and mass casualty incidents; the potential contributions of air transport services in these situations are not discussed in this paper since they have been outlined in Prehospital Emergency Care. 14 In summary, the guidelines that follow are offered as a noncomprehensive overview of clinical and logistical situations in which air medical dispatch may be appropriate.…”

On-Site Hospital Helipads: Resource Document for the NAEMSP Position Paper on On-Site Hospital Helipads

“…This prolongs transport for patients with multisystem trauma or illnesses (e.g., myocardial infarction, stroke) who need urgent access to time-sensitive interventions. [8][9][10] While it is not easy to pinpoint cause and effect for specific adverse events associated with delays incurred by employing an additional ground transport leg, there can be little argument that patients with acute trauma, coronary syndromes, strokes, or other obviously time-critical diagnoses are better served by minimizing transport times. Prolonged prehospital time due to patient access issues has been highlighted by a 2005 report 11 that argued even a few minutes' delay (incurred in getting to patients above the third floor of high-rise buildings) was a sufficient problem to constitute grounds for clinical concern.…”

Access to cardiac catheterization services in a rural-urban setting in northern British Columbia: Examining the impact of time-delay to PCI on patient outcomes and whether the sickest go the quickest..

“…The AIR-PAMI study by Grines et al (2002) involved high-risk AMI patients (aged 70 years or older, anterior MI, Killip class II/III, heart rate greater than 100 beats/min or systolic blood pressure less than 100 mm Hg) who were eligible for thrombolytic therapy. Patients (n= 138) were randomized to either of two treatment arms, transfer for primary PTCA (n=71) or on-site thrombolysis (n=67).…”

“…At 30 days, a 38% reduction in major adverse cardiac events was observed for the transfer group however, because of the inability to recruit the necessary sample size, this did not achieve statistical significance (8.4% versus 13.6%, p = 0.331). Grines et al (2002) concluded that high-risk patients with AMI at hospitals without a catheterization laboratory may have an improved outcome when transferred for primary PTCA versus on-site thrombolysis and suggested that the marked delay in the transfer process suggests a role for triaging patients directly to specialized heart-attack centers.…”

“…When compared to thrombolysis, primary PCI is considered to be the more effective strategy in reducing rates of re-infarction and stroke (Bohmer et al, 2003). This being said, transfer for primary PCI was seen as an effective intervention provided the transfer time was within 2 hours after thrombolytic therapy (Grines et al, 2002;Andersen et al, 2003;Nielsen et al, 2010). However thrombolysis still remains the treatment o f choice in ST-segment elevation myocardial infarction (STEMI) when primary PCI cannot be performed within 90 to 120 min (Levine et al, 2011).…”