Stenting versus thrombolysis in Acute Myocardial Infarction Trial (STAT)

OBJECTIVES We sought to directly compare primary stenting with accelerated tissue plasminogen activator (t-PA) in patients presenting with acute ST-el evation myocardial infarction (AMI). BACKGROUND Thrombolysis remains the standard therapy for AMI. However, at s ome institutions primary angioplasty is favored. Randomized trials have sho wn that primary angioplasty is equal or superior to thrombolysis, while rec ent studies demonstrate that stent implantation improves the results of pri mary angioplasty. METHODS Patients presenting with AMI were randomly assigned to primary sten ting (n = 62) or accelerated t-PA (n = 61). The primary end point was the c omposite of death, reinfarction, stroke or repeat target vessel revasculari zation PVR) for ischemia at six months. RESULTS The primary end point was significantly reduced in the stent group compared with the accelerated t-PA group, 24.2% versus 55.7% (p < 0.001). T he event rates for other outcomes in the stent group versus the t-PA group were as follows: mortality: 4.8% versus 3.3% (p = 1.00); reinfarction: 6.5% versus 16.4% (p = 0.096); stroke: 1.6% versus 4.9% (p = 0.36); recurrent u nstable ischemia: 9.7% versus 26.2% (p = 0.03) and repeat TVR for ischemia: 14.5% versus 49.2% (p < 0.001). The median length of the initial hospitali zation was four days in the stent group and seven days in the t-PA group (p < 0.001). CONCLUSIONS Compared with accelerated t-PA, primary stenting reduces death, reinfarction, stroke or repeat TVR for ischemia. In centers where faciliti es and experienced interventionists are available, primary stenting offers an attractive alternative to thrombolysis. (J Am Coll Cardiol 2001;37:985-9 1) (C) 2001 by the American College of Cardiology.