Transfer for urgent percutaneous coronary intervention early after thrombolysis for ST-elevation myocardial infarction: The TRANSFER-AMI pilot feasibility study

Abstract

Transfer of high-risk STEMI patients for urgent PCI within 6 h after thrombolysis appears feasible. The randomized trial phase of the Trial of Routine ANgioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) will compare this strategy with standard treatment after thrombolysis.

Clinical Outcomes of Early Repatriation for Patients With ST-Segment Elevation Myocardial Infarction: A Propensity-Matched Analysis

“…A small feasibility study of high-risk STEMI patients transferred from community hospitals who underwent PCI within 6 hours of thrombolysis, and were repatriated at a median time of 24 hours after PCI, showed no deaths or reinfarctions in most of these patients at 1-year follow-up. 7 This was confirmed in a larger study of 1479 STEMI patients who presented to a major PCI tertiary centre, over a 4-year period from June 1, 2003 to June 30, 2007, which also found no significant difference in in-hospital mortality for repatriated vs nonrepatriated patients. 8 This study was limited by its focus on in-hospital outcomes.…”

“…[1][2][3] However, most hospitals in Canada do not have on-site PCI capability and as such, almost 80% of patients with STEMI initially present at a non-PCI centre. [4][5][6][7] Many PCI centres have an established repatriation program whereby STEMI patients, either from the catchment area or directly referred from an acute non-PCI hospital, are repatriated within 24 hours after their initial reperfusion therapy. 8,9 Because of limitations on bed capacity at PCI centres, this repatriation is an important component of STEMI care.…”

“…8 Another study by Cantor and colleagues reported no complications after transferring 15 high-risk STEMI patients to the sending community hospitals within 24-48 hours after primary PCI. 7 Although reassuring, these studies had several limitations, the most notable of which is the absence of longer-term outcomes after discharge.…”

Early routine angioplasty versus selective angioplasty after successful thrombolysis in acute ST-segment elevation myocardial infarction

“…The rationale for timely but not too early intervention is not only to avoid bleeding complications but also to decrease reocclusion rates. In the study of TRANSFER-AMI, patients who had a myocardial infarction with ST-segment elevation and who were treated with thrombolysis, transferred for PCI within 6 h after thrombolysis, had significantly fewer ischemic complications than the standard treatment [18,19]. A time interval between 3 and 24 h after thrombolysis improved event-free survival compared with conservative treatment [11,[20][21][22][23][24].…”

Ultra Early Routine Post-Fibrinolysis Angioplasty Benefits More Patients with Acute ST-Elevation Myocardial Infarction

“…Thrombolysis therapy has the characteristics of rapid, simple and is easy to operate. In the modern era of percutaneous coronary intervention, early routine post-fibrinolytic angiography and stenting may improve outcomes [3] [4]. This approach combines the advantages of rapid and simple use of fibrinolysis for myocardial salvage with the advantages of stenting in achieving a normal stable flow, and is a reasonable alternative to primary angioplasty.…”