52 in 52: Angioplasty vs ‘Lytics in AMI

LyticsvsPCI

http://www.nejm.org/doi/full/10.1056/NEJMoa025142

Our second week installment of ALiEM’s 52 Articles in 52 Weeks.
(More info @ http://academiclifeinem.com/52-articles-in-52-weeks-landmark-em-articles-2013/)

Quick Fix:
Previous studies demonstrated the superiority of PCI over thrombolytics in treating STEMIs. Not all hospitals have cath labs, so is there benefit to transferring STEMI pts presenting in the community to facilities that can perform PCI?

This study’s composite endpoint demonstrated there was a benefit; the composite consisted of mortality, reinfarction, and stroke. There was a 75% relative risk reduction of reinfarction seen in PCI over ‘Lytics. However, “the reduction in the risks of death and stroke did not reach statistical significance.

It’s also worth mentioning that 4% of the pts screened were not stable enough to be transferred. Of 559 pts who eventually did get transferred, 35 developed arrhythmias, with no deaths en route, leading the authors to conclude “the transfer of patients was found to be safe.

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