This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Le May, M. R. Articles by Higginson, L. A. Search for Related Content PubMed PubMed Citation Articles by Le May, M. R. Articles by Higginson, L. A.

CLINICAL STUDY: MYOCARDIAL INFARCTION

Stenting versus thrombolysis in acute myocardial infarction trial (STAT)

^a Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Canada

Manuscript received July 12, 2000; revised manuscript received October 24, 2000, accepted December 1, 2000.

Reprint requests and correspondence: Dr. Michel R. Le May, Ottawa Heart Institute, 40 Ruskin Street, Ottawa, Ontario, Canada K1Y 4W7
mlemay{at}ottawaheart.ca

OBJECTIVES

We sought to directly compare primary stenting with accelerated tissue plasminogen activator (t-PA) in patients presenting with acute ST-elevation myocardial infarction (AMI).

BACKGROUND

Thrombolysis remains the standard therapy for AMI. However, at some institutions primary angioplasty is favored. Randomized trials have shown that primary angioplasty is equal or superior to thrombolysis, while recent studies demonstrate that stent implantation improves the results of primary angioplasty.

METHODS

Patients presenting with AMI were randomly assigned to primary stenting (n = 62) or accelerated t-PA (n = 61). The primary end point was the composite of death, reinfarction, stroke or repeat target vessel revascularization (TVR) for ischemia at six months.

RESULTS

The primary end point was significantly reduced in the stent group compared with the accelerated t-PA group, 24.2% versus 55.7% (p < 0.001). The event rates for other outcomes in the stent group versus the t-PA group were as follows: mortality: 4.8% versus 3.3% (p = 1.00); reinfarction: 6.5% versus 16.4% (p = 0.096); stroke: 1.6% versus 4.9% (p = 0.36); recurrent unstable ischemia: 9.7% versus 26.2% (p = 0.03) and repeat TVR for ischemia: 14.5% versus 49.2% (p < 0.001). The median length of the initial hospitalization was four days in the stent group and seven days in the t-PA group (p < 0.001).

CONCLUSIONS

Compared with accelerated t-PA, primary stenting reduces death, reinfarction, stroke or repeat TVR for ischemia. In centers where facilities and experienced interventionists are available, primary stenting offers an attractive alternative to thrombolysis.

Abbreviations and Acronyms   AMI = acute ST-elevation myocardial infarction   CABG = coronary bypass surgery   GUSTO = Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes trial   IRA = infarct-related artery   LBBB = left bundle branch block   PAMI = Primary Angioplasty in Myocardial Infarction trial   PTCA = percutaneous transluminal coronary angioplasty   STENTIM = STENTing In acute Myocardial infarction trial   t-PA = tissue plasminogen activator   TIMI = Thrombolysis In Myocardial Infarction   TVR = target vessel revascularization

This article has been cited by other articles:

				T. Huynh, S. Perron, J. O'Loughlin, L. Joseph, M. Labrecque, J. V. Tu, and P. Theroux Comparison of Primary Percutaneous Coronary Intervention and Fibrinolytic Therapy in ST-Segment-Elevation Myocardial Infarction: Bayesian Hierarchical Meta-Analyses of Randomized Controlled Trials and Observational Studies Circulation, June 23, 2009; 119(24): 3101 - 3109. [Abstract] [Full Text] [PDF]

				C. Asseburg, Y. Bravo Vergel, S. Palmer, E. Fenwick, M. de Belder, K. R Abrams, and M. Sculpher Assessing the effectiveness of primary angioplasty compared with thrombolysis and its relationship to time delay: a Bayesian evidence synthesis Heart, October 1, 2007; 93(10): 1244 - 1250. [Abstract] [Full Text] [PDF]

				J. R. Timmer, J. P. Ottervanger, M.-J. de Boer, E. Boersma, C. L. Grines, C. M. Westerhout, R. J. Simes, C. B. Granger, F. Zijlstra, and for the Primary Coronary Angioplasty vs Thrombolys Primary Percutaneous Coronary Intervention Compared With Fibrinolysis for Myocardial Infarction in Diabetes Mellitus: Results From the Primary Coronary Angioplasty vs Thrombolysis-2 Trial Arch Intern Med, July 9, 2007; 167(13): 1353 - 1359. [Abstract] [Full Text] [PDF]

				C. S. Hollenbeak, J. P. Fitzgibbons, M. Rossi, D. L. Morris, and P. Stillman The Impact of Percutaneous Coronary Interventions on Outcomes for Acute Myocardial Infarction in Pennsylvania American Journal of Medical Quality, March 1, 2007; 22(2): 85 - 94. [Abstract] [PDF]

				H. H. Ting, E. H. Yang, and C. S. Rihal Narrative review: reperfusion strategies for ST-segment elevation myocardial infarction. Ann Intern Med, October 17, 2006; 145(8): 610 - 617. [Abstract] [Full Text] [PDF]

				E. Boersma and The Primary Coronary Angioplasty vs. Thrombolysis Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients Eur. Heart J., April 1, 2006; 27(7): 779 - 788. [Abstract] [Full Text] [PDF]

				Part 5: Acute Coronary Syndromes Circulation, November 29, 2005; 112(22_suppl): III-55 - III-72. [Full Text] [PDF]

				K. Huber, R. D. Caterina, S. D. Kristensen, F. W.A. Verheugt, G. Montalescot, L. B. Maestro, F. V. d. Werf, and for the Task Force on Pre-hospital Reperfusion The Pre-hospital reperfusion therapy: a strategy to improve therapeutic outcome in patients with ST-elevation myocardial infarction Eur. Heart J., October 1, 2005; 26(19): 2063 - 2074. [Full Text] [PDF]

				M. R. Le May, G. A. Wells, M. Labinaz, R. F. Davies, M. Turek, D. Leddy, J. Maloney, T. McKibbin, B. Quinn, R. S. Beanlands, et al. Combined Angioplasty and Pharmacological Intervention Versus Thrombolysis Alone in Acute Myocardial Infarction (CAPITAL AMI Study) J. Am. Coll. Cardiol., August 2, 2005; 46(3): 417 - 424. [Abstract] [Full Text] [PDF]

				Writing Committee Members, E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, et al. ACC/AHA guidelines for the management of patients with ST-Elevation myocardial infarction--executive summary: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction) J. Am. Coll. Cardiol., August 4, 2004; 44(3): 671 - 719. [Full Text] [PDF]

				E. M. Antman, D. T. Anbe, P. W. Armstrong, E. R. Bates, L. A. Green, M. Hand, J. S. Hochman, H. M. Krumholz, F. G. Kushner, G. A. Lamas, et al. ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction--Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients With Acute Myocardial Infarction) Circulation, August 3, 2004; 110(5): 588 - 636. [Full Text] [PDF]

				M. R. Le May, R. F. Davies, M. Labinaz, H. Sherrard, J.-F. Marquis, L. A. Laramee, E. R. O'Brien, W. L. Williams, R. S. Beanlands, G. Nichol, et al. Hospitalization Costs of Primary Stenting Versus Thrombolysis in Acute Myocardial Infarction: Cost Analysis of the Canadian STAT Study Circulation, November 25, 2003; 108(21): 2624 - 2630. [Abstract] [Full Text] [PDF]

				N. Freemantle, M. Calvert, J. Wood, J. Eastaugh, and C. Griffin Composite Outcomes in Randomized Trials: Greater Precision But With Greater Uncertainty? JAMA, May 21, 2003; 289(19): 2554 - 2559. [Abstract] [Full Text] [PDF]

				F Zijlstra Angioplasty vs thrombolysis for acute myocardial infarction: a quantitative overview of the effects of interhospital transportation Eur. Heart J., January 1, 2003; 24(1): 21 - 23. [Full Text] [PDF]

				V. S. Mahadevan, D. McCarty, and A. A. J. Adgey Platelet GPIIb/IIIa receptor blockers for failed thrombolysis in acute myocardial infarction, alone or as adjunct to other rescue therapies Eur. Heart J., October 1, 2002; 23(19): 1490 - 1491. [Full Text] [PDF]

				P. Widimsky Reperfusion damage or no-reflow damage in primary coronary interventions in acute myocardial infarction? Eur. Heart J., July 2, 2002; 23(14): 1076 - 1078. [Full Text] [PDF]