Long-term outcomes of patients with acute myocardial infarction presenting to hospitals without catheterization laboratory and randomized to immediate thrombolysis or interhospital transport for primary percutaneous coronary intervention. Five years' follow-up of the PRAGUE-2 trial

• Published in: European heart journal Vol. 28; no. 6; pp. 679 - 684
• Main Authors: Widimsky, Petr, Bilkova, Dana, Penicka, Martin, Novak, Martin, Lanikova, Miroslava, Porizka, Vladimir, Groch, Ladislav, Zelizko, Michael, Budesinsky, Tomas, Aschermann, Michael
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-03-2007; Oxford Publishing Limited (England)
• Subjects: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary - methods; Angioplasty, Balloon, Coronary - mortality; Biological and medical sciences; Cardiology. Vascular system; Coronary heart disease; Disease-Free Survival; Diseases of the cardiovascular system; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocarditis. Cardiomyopathies; Patient Transfer; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Recurrence; Thrombolytic Therapy - methods; Thrombolytic Therapy - mortality; Myocardial infarction; Interhospital transport; Long-term outcome; Thrombolysis; Primary coronary intervention; Prognosis; Angioplasty; Cardiovascular disease; Laboratory; Myocardial disease; Phlebology; Stent; Randomization; Primary; Clinical trial; Evolution; Hospital; Cardiology; Human; Catheterization; Acute; Coronary artery; Instrumentation therapy; Patient; Coronary heart disease; Fibrinolysis; Long term; Follow up study; Circulatory system; Transport
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehl535

Aim Randomized trials in ST-elevation myocardial infarction (STEMI) showed improved early outcomes after primary percutaneous coronary intervention (p-PCI) compared with thrombolysis (TL). It is less known whether the early benefit is sustained during the long-term follow-up.
Methods and results The PRAGUE-2 trial enrolled 850 STEMI patients presenting to community hospitals without cath-labs within 12 h of symptom onset. Patients were randomized into the groups 'TL in community hospital' (n = 421) and 'interhospital transfer for p-PCI' (n = 429).
Follow-up data were available in 416 (98.8%) patients in the TL group and 428 (99.8%) in the p-PCI group. At 5 year follow-up, the cumulative incidence of composite endpoint (death from any cause or recurrent infarction or stroke or revascularization) was 53% in TL patients compared with 40% in p-PCI patients (HR 1.8; 95% CI 1.38-2.33; P < 0.001). The respective cumulative incidence of death from any cause was 23 and 19% (HR 1.34; 95% CI 0.99-1.82; P = 0.06), recurrent infarction 19 vs. 12% (HR 1.72; 95% CI 1.15-2.58; P = 0.009), stroke 8 vs. 8% (HR 1.65; 95% CI 0.84-2.23; P = 0.18), revascularization 51 vs. 34% (HR 1.81; 95% CI 1.21-2.35; P < 0.001).
Conclusion The early benefit from the p-PCI strategy (over TL) is sustained during the 5 years' follow-up. It can be almost exclusively derived from differences in event rate during the first month.