5 Years of FAST-MI: If Unable to Meet the Timeline, Thrombolization Is the Way to Go

A large proportion of patients undergo primary angioplasty beyond the timelines recommended by clinical practice guidelines. These patients have poorer 5-year outcomes compared with those subjected to a pharmaco-invasive strategy.

ST-segment elevation myocardial infarction guidelines recommend primary angioplasty as the strategy of choice within 120 min after a diagnostic electrocardiography. If that is not possible, thrombolytic therapy is preferable. However, there is little direct evidence supporting such recommendation.

This work, soon to be published in the European Heart Journal, seeks to analyze the 5-year outcomes of early primary angioplasty vs. primary angioplasty that required a referral to another site vs. a pharmaco-invasive strategy (thrombolytic therapy first, and then referral to a primary angioplasty specialized site).

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Among 4250 patients with ST-segment elevation myocardial infarction between 2005 and 2010, only 2942 consulted a physician within 12 hours after the onset of symptoms. Among the latter, 54% underwent primary angioplasty within 120 min from first medical contact, 28% underwent angioplasty after 120 min, and 28% received fibrinolysis.

Five-year survival was higher with a pharmaco-invasive strategy (89.8%) compared with angioplasty after 120 min (79.5%; hazard ratio [HR]: 1.51). Early thrombolytic therapy was even as good as timely primary angioplasty (mortality: 89.8% vs. 88.2%; HR: 1.02).

Results were still concordant after multiple adjustments.

Conclusion

A significant number of patients undergo primary angioplasty beyond the timelines recommended by clinical practice guidelines. Patients treated beyond 120 min after first medical contact have worse prognosis than those who receive thrombolytic therapy immediately.

Original Title: Five-year outcomes following timely primary percutaneous intervention, late primary percutaneous intervention, or a pharmacoinvasive strategy ST-segment elevation myocardial infarction: the FAST-MI programme. 

Reference: Nicolas Danchin et al. European Heart Journal, article in press.

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