Fibrinolysis versus primary percutaneous intervention in ST-elevation myocardial infarction with long interhospital transfer distances

Clin Cardiol. 2010 Mar;33(3):162-7. doi: 10.1002/clc.20723.


Background: Current guidelines recommend rapid initiation of reperfusion therapy for ST-elevation myocardial infarction (STEMI), with short-distance transfer for primary percutaneous coronary intervention (pPCI) preferred over fibrinolysis in non-pPCI-capable hospitals. Comparative outcomes in patients with longer transfer times are unclear.

Hypothesis: We designed this study to assess whether administering fibrinolytics prior to initiating longer-distance interhospital transfer in patients with STEMI leads to a delay in transfer or worse outcomes compared with transfer for pPCI.

Methods: We analyzed 259 STEMI patients transferred to a receiving pPCI-capable center in eastern North Carolina. The patients were divided into 2 groups, with 43 (16.6%) transferred for pPCI and the remaining 216 (83.4%) transferred following fibrinolysis. The primary endpoint was door-to-door time. We also compared stroke, death, significant bleeding, and combined outcomes between the 2 groups.

Results: The median door-to-door time was similar for pPCI and fibrinolysis patients (135 vs 128 minutes; P = 0.71). Median door-to-balloon time among pPCI patients was 182 minutes from the point of arrival at the referral hospital and 49 minutes from arrival at the receiving pPCI center. Median door-to-needle time in the fibrinolysis patients was 30 minutes, with rescue PCI eventually performed in 81 (37.5%) patients. In-hospital mortality was higher in patients with pPCI (9.3%) compared with fibrinolysis patients (1.9%; P = 0.03). Combined incidence of stroke, significant bleeding, and death was 14% in pPCI patients compared with 7% in fibrinolysis patients (P = 0.13).

Conclusions: In settings with longer transfer distances, administering fibrinolytics prior to transfer to a pPCI-capable center did not cause any significant delay in transfer or worse outcomes.

Publication types

  • Comparative Study

MeSH terms

  • Aged
  • Analysis of Variance
  • Angioplasty, Balloon, Coronary / methods*
  • Angioplasty, Balloon, Coronary / statistics & numerical data
  • Female
  • Fibrinolytic Agents / therapeutic use*
  • Hospital Mortality
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / drug therapy*
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • Myocardial Reperfusion
  • North Carolina
  • Patient Transfer / statistics & numerical data*
  • Registries
  • Retrospective Studies
  • Stroke
  • Time Factors
  • Treatment Outcome


  • Fibrinolytic Agents