TRANSFER AMI Trial Summary: Early Angioplasty after Fibrinolysis for Acute MI

transfer ami trial early angioplasty after lytics

2009 TRANSFER-AMI trial: Routine Early Angioplasty after Fibrinolysis for Acute Myocardial Infarction Multicenter, randomized, non-blinded, parallel Assignment Objective: To assess outcomes in patients with AMI treated with thrombolysis transferring to a center providing PCI for standard treatment (rescue PCI or delayed angiography) vs immediate transfer within 6 hours of fibrinolysis 1059 Patients > 18 years presenting within 12 hours of symptom onset with > 30 min of continuous symptoms of AMI and ST segment elevations on ECG to a center that does not perform primary PCI patients Early-PCI N=537 Standard treatment N=522 PRIMARY OUTCOME 11 30 Day Mortality and CV complications % HR 0.64, 95% CI 0.47 to 0.87, P=0.004 17.2 SECONDARY OUTCOME 8.9 6 month death or reinfarction % HR 0.83, 95% CI 0.55-1.25, p=0.36 10.6 20.5 Bleeding complications % HR 1.27, 95% CI 0.98-1.65, p=0.06 16.1 Conclusion: Among high-risk patients who had a myocardial infarction with ST-segment elevation and who were treated with fibrinolysis, transfer for PCI within 6 hours after fibrinolysis was associated with significantly fewer ischemic complications than was standard treatment. Cantor WJ et al. NEJM. 2009; 360(26):2705-2718 Summary by Dr Kiriti S. Vattikonda, D.O