Multicentre randomized trial comparing transport to primary angioplasty vsimmediate thrombolysis vs combined strategy for patients with acute myocardial infarction presenting to a community hospital without a catheterization laboratory - The PRAGUE study

Background Primary coronary angioplasty is an effective reperfusion strateg y in acute myocardial infarction. However, its availability is limited, and transporting patients to an angioplasty centre in the acute phase of myoca rdial infarction has not yet been proved safe. Methods The PRAGUE study (PRimary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emerg ency thrombolysis) compared three reperfusion strategies in patients with a cute myocardial infarction, presenting within 6 h of symptom onset at commu nity hospitals without a catheterization laboratory: group A - thrombolytic therapy in community hospitals (n=99), group B - thrombolytic therapy duri ng transportation to angioplasty (n=100), group C - immediate transportatio n for primary angioplasty without pre-treatment with thrombolysis (n=101). Results No complications occurred during transportation in group C. Two ven tricular fibrillations occurred during transportation in group B. Median ad mission-reperfusion time in transported patients (group B 106 min, group C 96 min) compared favourably with the anticipated >90 min in group A. The co mbined primary end-point (death/reinfarction/stroke at 30 days) was less fr equent in group C (8%) compared to groups B (15%) and A (23%, P<0.02). The incidence of reinfarction was markedly reduced by transport to primary angi oplasty (1% in group C vs 7% in group B vs 10% in group A, P<0.03). Conclusions Transferring patients from community hospitals to a tertiary an gioplasty centre in the acute phase of myocardial infarction is feasible an d safe. This strategy is associated with a significant reduction in the inc idence of reinfarction and the combined clinical end-point of death reinfar ction/stroke at 30 days when compared to standard thrombolytic therapy at t he community hospital. (Eur Heart J 2000; 21: 823-831) (C) 2000 The Europea n Society of Cardiology.