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J Am Coll Cardiol, 2004; 43:1943-1950, doi:10.1016/j.jacc.2004.03.013
© 2004 by the American College of Cardiology Foundation
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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

Primary Angioplasty in Acute Myocardial Infarction at Hospitals With No Surgery On-Site (the PAMI-No SOS study) versus transfer to surgical centers for primary angioplasty

Thomas P. Wharton, Jr, MD, FACC*,*, Lorelei L. Grines, PhD{dagger}, Mark A. Turco, MD, FACC{ddagger}, James D. Johnston, MD, FACC§, Jane Souther, MD, FACC||, David C. Lew, MD, FACC, Ajazuddin Z. Shaikh, MD, FACC#, William Bilnoski, MD, FACC**, Sushil K. Singhi, MD, FACC{dagger}{dagger}, A. Ersin Atay, MD, FACC{ddagger}{ddagger}, Nancy Sinclair, BSN*, Dawn E. Shaddinger, MSN{ddagger}, Mark Barsamian, DO{dagger}, Mariann Graham, BSN{dagger}, Judith Boura, MS{dagger} and Cindy L. Grines, MD, FACC{dagger}

* Division of Cardiology, Exeter Hospital, Exeter, New Hampshire, USA
{dagger} Department of Cardiology, William Beaumont Hospital, Royal Oak, Michigan, USA
{ddagger} Doylestown Hospital, Doylestown, Pennsylvania, USA
§ Hilton Head Hospital, Hilton Head, South Carolina, USA
|| Blount Memorial Hospital, Maryville, Tennessee, USA
Leesburg Regional Medical Center, Leesburg, Florida, USA
# St. Joseph Community Hospital, Mishawaka, Indiana, USA
** Auburn Regional Medical Center, Auburn, Washington, USA
{dagger}{dagger} Piedmont Medical Center, Rock Hill, South Carolina, USA
{ddagger}{ddagger} Mercy Medical Center, Cedar Rapids, Iowa, USA

Manuscript received August 14, 2003; revised manuscript received October 21, 2003, accepted October 28, 2003.

* Reprint requests and correspondence: Dr. Thomas P. Wharton, Jr., The Perry Medical Services Building, Suite 101, 3 Alumni Drive, Exeter, New Hampshire 03833, USA.
tom.wharton{at}comcast.net

OBJECTIVES: To investigate primary angioplasty (PA) for high-risk acute myocardial infarction (AMI) at hospitals with no cardiac surgery on-site (No SOS), we hypothesized that a nonrandomized registry of such patients treated with PA would show clinical outcomes similar to those of a group randomized to transfer for PA, and that reperfusion would occur faster.

BACKGROUND: Primary angioplasty provides outcomes superior to fibrinolytic therapy in AMI, but its use in community hospitals with No SOS has been limited.

METHODS: Fibrinolytic-eligible patients with high-risk AMI prospectively consented if they had one or more high-risk characteristic. Nineteen hospitals with No SOS prospectively enrolled 500 patients for PA on-site. Seventy-one similar Air Primary Angioplasty in Myocardial Infarction trial patients were randomized to transfer for PA.

RESULTS: Primary angioplasty was performed in 88% of patients. Patients transferred for PA had a longer mean time to treatment (187 vs. 120 min; p < 0.0001). Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 was achieved in 96% for on-site PA, 86% in the transfer group (p = 0.004). The combined primary end point of 30-day mortality, re-infarction, and disabling stroke occurred in 27 (5%) on-site PA patients and 6 (8.5%) transfer patients (p = 0.27). Unadjusted one-year mortality was improved in on-site PA patients compared with those transferred (6% vs. 13%, p = 0.043), but after adjustment for differences in baseline variables, this difference was not significant.

CONCLUSIONS: On-site PA and transfer groups had similar 30-day outcomes and more rapid reperfusion for on-site PA. Primary angioplasty in high-risk AMI patients at hospitals with No SOS is safe, effective, and faster than PA after transfer to a surgical facility.

Abbreviations and Acronyms
  AMI = acute myocardial infarction
  EC = emergency center
  ECG = electrocardiographic
  No SOS = No cardiac Surgery On-Site study
  NRMI = National Registry of Myocardial Infarction
  PA = primary angioplasty
  PAMI = Primary Angioplasty in Myocardial Infarction trial
  PCI = percutaneous coronary intervention
  TIMI = Thrombolysis In Myocardial Infarction




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