Cor Vasa 2003, 44(3):150-155
Meta-analysis of the PRAGUE 1 + 2 studies
- 1 Kardiocentrum, Fakultní nemocnice Královské Vinohrady, Praha
- 2 I. interní klinika, Oddělení invazivní a intervenční kardiologie, Fakultní nemocnice u sv. Anny, Brno
- 3 Klinika kardiologie, Institut klinické a experimentální medicíny
- 4 II. interní klinika, Všeobecná fakultní nemocnice, Praha
- 5 Kardiocentrum, Nemocnice Třinec-Podlesí
- 6 Kardiocentrum, Fakultní nemocnice, Hradec Králové
- 7 Kardiologická klinika, Nemocnice Na Homolce, Praha, Česká republika, a 50 dalších nemocnic v České republice
Background:
Primary coronary intervention (PCI) has been shown to be the most effective reperfusion strategy in acute myocardial infarction. This meta-analysis summarizes main data from two national multicenter randomized studies.
Methods:
The "PRAGUE-1" and "PRAGUE-2" studies randomized 1,150 patients with acute ST-elevation myocardial infarction presenting within < 12 hours to the nearest community hospital without a cath lab to either thrombolysis in the hospital (TL group, n = 520), or immediate transport for primary percutaneous coronary intervention (PCI group, n = 530), or a combined strategy-thrombolysis during transport (n = 100, not included in this meta-analysis). The primary end-point in this meta-analysis was 30-day mortality. Secondary end-points were: death /reinfarction/ stroke at 30 days (combined end-point) and 30-day mortality related to treatment onset time (pain to randomization). Maximum transport distance was 120 km.
Results:
Seven complications (two deaths and 5 episodes of ventricular fibrillation) occurred during transport. Mortality at 30 days was 10.8% in the TL group compared to 6.8% mortality in the PCI group (p < 0.04, intention-to-treat analysis). Among patients randomized > 3 hours after the onset of symptoms, mortality of the TL group reached 16.5% compared to 5.4% in the PCI group (p < 0.002). Patients randomized within < 3 hours of symptom onset showed no significant difference in mortality whether treated by TL (8%) or transferred to PCI (7.6%). The combined end-point occurred in 16.7% of TL group patients vs. 8.3% of PCI group patients (p < 0.0001).
Conclusions:
Long-distance transfer from a community hospital to a tertiary PCI center in the acute phase of AMI is safe. This strategy markedly decreases mortality among patients presenting > 3 hours after symptom onset and markedly decreases the risk of reaching the combined clinical end-point among all patients.
Keywords: Acute myocardial infarction; Thrombolysis; Long-distance transport; Coronary angioplasty; Stent
Published: March 1, 2003 Show citation