This study continues an ongoing search for what to do. Right now the standard is to get the patient to the cath lab in 90 minutes.
But this French study says fibrinolytics have good 5 years survivals.
No camparison on the cost, cath lab is expensive and around the world not always available in 90 minutes. In some places a little bit of clot buster produces good results, risk of stroke though.
Five-Year Survival in Patients With ST-Segment Elevation Myocardial Infarction According to Modalities of Reperfusion Therapy: The French Registry on Acute ST-Elevation and Non-ST-Elevation Myocardial Infarction (FAST-MI) 2005 Cohort
Circulation 2014 Mar 21;[EPub Ahead of Print], N Danchin, E Puymirat, PG Steg, P Goldstein, F Schiele, L Belle, Y Cottin, J Fajadet, K Khalife, P Coste, J Ferrières, T Simon
Although primary percutaneous coronary intervention (pPCI) is the preferred reperfusion method for ST-elevation myocardial infarction (STEMI), it remains difficult to implement in many areas, and fibrinolytic therapy is still widely used.
METHODS AND RESULTS
We assessed 5-year mortality in STEMI patients from the French registry of Acute ST-elevation or non-ST elevation Myocardial Infarction (FAST-MI) 2005 according to use and type of reperfusion therapy. Of 1492 STEMI patients with first call ≤12 hours from onset, 447 (30%) received fibrinolysis (66% pre-hospital; 97% with subsequent angiography, 84% with subsequent PCI), 583 (39%) had pPCI and 462 (31%) received no reperfusion. Crude 5-year survival was 88% for fibrinolytic-based strategy, 83% for pPCI and 59% for no reperfusion. Adjusted hazard ratios (95% confidence interval) for 5-year death were: 0.73 (0.50-1.06) for fibrinolysis versus pPCI, 0.57 (0.36-0.88) for pre-hospital fibrinolysis versus pPCI, and 0.63 (0.34-0.91) for fibrinolysis vs pPCI beyond 90 minutes of call in patients having called ≤180 minutes from onset. In propensity score matched populations, however, survival rates were not significantly different for fibrinolysis and pPCI, both in the whole population (88% lysis, 85% pPCI), and in the population seen early (87% fibrinolysis, 85% pPCI beyond 90 minutes from call).
In a real world setting, on a nationwide scale, a pharmaco-invasive strategy constitutes a valid alternative to pPCI, with 5-year survival at least equivalent to the reference reperfusion method.