Consider The Evidence: Med/Peds Journal Roundup

February 20, 2006

Facilitated PCI a bust yet again

Filed under: Cardiology, lancet, myocardial infarction, PCI — medblog @ 3:22 pm

Lancet 2/20 – There has been some buzz of late about facilitated percutaneous coronary intervention (PCI) – using fibrinolytics before going to the cath lab in order to increase the critical 2-3 hour window of opportunity for reperfusion. An article by the ASSENT4-PCI group in this weeks Lancet adds to the data that such a strategy is not beneficial.

The study enrolled about 1600 patients from several countries who were expected to arrive at the cath lab between 1 and 3 hrs of symptom onset. About half were randomized to receive a bolus of tenecteplase. The median time to first balloon was the same in both groups. Bottom line: the facilitated PCI group had higher rates of morbidity and mortality – especially stroke and cardiogenic shock, despite greater patency rates.

Assessment of the Safety and Efficacy of a New Treatment Strategy with Percutaneous Coronary Intervention (ASSENT-4 PCI) investigators, Primary versus tenecteplase-facilitated percutaneous coronary intervention in patients with ST-segment elevation acute myocardial infarction (ASSENT-4 PCI): randomised trial, The Lancet, Volume 367, Issue 9510, 18 February 2006-24 February 2006, Pages 569-578.

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