The STREAM study (Strategic Reperfusion Early After Myocardial Infarction) that included 1891 patients gave support to the fibrinolytic infusion strategy in the ambulance in patients treated within 3 hours of stroke and who cannot receive primary angioplasty within the hour versus primary angioplasty. The primary end point was a composite of death from any cause, cardiogenic shock, heart failure and reinfarction within 30 days. At the ACC 2013 results for 30 days were presented, demonstrating similar events between the groups with a higher risk of intracranial bleeding for thrombolytics but with a nonsignificant reduction of 1.5 % in the incidence of cardiogenic shock and heart failure. At one year all-cause mortality was 6.7 % in the pharmacological-invasive group and 5.9 % in the primary angioplasty group (p = 0.52).
Conclusion:
Mortality from all causes and from cardiovascular cause was similar regardless of the strategy used, indicating that the pharmacological-invasive strategy may offer an alternative of reperfusion to a significant number of patients.
Peter Sinnaeve
2013-11-19
Original title: One Year Mortality in STEMI Patients Randomized to Primary PCI or a Pharmaco-invasive Strategy. The Stream 1 Year Follow-up
