Rationale and strategies for implementing community-based transfer protocols for primary percutaneous coronary intervention for acute ST-segment elevation myocardial infarction
Richard E. Waters, II, MD*,
Kanwar P. Singh, MD*,
Matthew T. Roe, MD, MHS, FACC*,*,
Mat Lotfi, MD*,
Michael H. Sketch, Jr, MD, FACC*,
Kenneth W. Mahaffey, MD, FACC*,
L. Kristin Newby, MD, MHS, FACC*,
John H. Alexander, MD, MHS, FACC*,
Robert A. Harrington, MD, FACC*,
Robert M. Califf, MD, FACC* and
Christopher B. Granger, MD, FACC*
* Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina, USA
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Figure 1 Mortality to 30 days for ST-segment elevation myocardial infarction patients treated with primary percutaneous transluminal coronary angioplasty (PTCA) versus fibrinolytic therapy (lytic). Reproduced with permission from the Primary Coronary Angioplasty Trialists' (PCAT) Collaborators (1). CI = confidence interval; SK = streptokinase; tPA = tissue plasminogen activator.
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Figure 2 Meta-analysis of short-term clinical outcomes in ST-segment elevation myocardial infarction patients treated with onsite fibrinolysis versus transfer for primary percutaneous transluminal coronary angioplasty (PTCA). Reproduced with permission from Keeley et al. (5).
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Figure 3 Mortality rates in clinical trials comparing onsite fibrinolysis (open bars) versus transfer for primary percutaneous coronary intervention (solid bars) for ST-segment elevation myocardial infarction. This figure is based on data presented by Keeley et al. (5). AIR-PAMI = Air Primary Angioplasty in Myocardial Infarction trial (12); DANAMI = Danish Multicenter Randomized Trial on Thrombolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction trial (9); LIMI = Limburg Intervention/MI trial (13); PCI = percutaneous coronary intervention; PRAGUE = Primary Angioplasty After Transport of Patients From General Community Hospitals to Catheterization Units With/Without Emergency Thrombolysis Infusion Trials (10,11).
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