Availability of on-site catheterization and clinical outcomes in patients receiving fibrinolysis for ST-elevation myocardial infarction

Aims To compare management and clinical outcomes in hospitals stratified by the availability or on-site catheterization in InTIME-II, a multicentre tr ial comparing alteplase with lanoteplase for acute myocardial infarction. Methods and Results We studied 15 078 patients enrolled in 35 countries and 855 hospitals. Thirty-one percent of hospitals had 24-h. 25% day-only, and 44% no on-site catheterization facilities. Rates of cardiac angiography (5 7%, 38%, 26%) and revascularization (37%, 21%, 17%) were higher in hospital s with increasing access to on-site facilities (P <0.0001). The presence of a 24-h on-site facility was the strongest predictor of angiography during the index admission (odds ratio 4.17, 95% CI 3.85-4.54). There were no majo r differences in patient outcomes at 30 days when hospitals were stratified by availability of on-site catheterization. Adjusted 1-year mortality was similar between groups of hospitals (odds ratio for day-only 0.94 [0.80-1.0 9] and odds ratio for no availability 0.95 [0.83-1.10] compared to hospital s with 24-h facilities). Conclusions There is a marked variation in procedure use by the availabilit y of on-site catheterization with no major differences in patient outcomes. There is a need for additional randomized trials in the Current era to add ress both the appropriate selection of patients and timing of invasive proc edures in ST-elevation acute myocardial infarction. (C) 2001 The European S ociety of Cardiology.