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Title: ST-Segment-Elevation Myocardial Infarction Patients Randomized to a Pharmaco-Invasive Strategy or Primary Percutaneous Coronary Intervention Strategic Reperfusion Early After Myocardial Infarction (STREAM) 1-Year Mortality Follow-Up
Authors: Sinnaeve, Peter R.
Armstrong, Paul W.
Gershlick, Anthony H.
Goldstein, Patrick
Wilcox, Robert
Lambert, Yves
Danays, Thierry
Soulat, Louis
Halvorsen, Sigrun
Rosell Ortiz, Fernando
Vandenberghe, Katleen
Regelin, Anne
Bluhmki, Erich
Van de Werf, Frans
Issue Date: 2014
Source: CIRCULATION, 130 (14), p. 1139-1145
Abstract: Background-In the Strategic Reperfusion Early After Myocardial Infarction (STREAM) trial, a pharmaco-invasive (PI) strategy was compared with primary percutaneous coronary intervention (pPCI) in ST-segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset but unable to undergo pPCI within 1 hour. At 30 days, the PI approach was associated with a nominally but nonstatistically significant lower incidence of the composite primary end point of death, shock, congestive heart failure, and reinfarction when compared with pPCI. The aim of the present study was to determine the effect of these strategies on 1-year mortality. Methods and Results-Vital status at 1 year was available in 936 of 944 (99.2%) and 941 of 948 (99.3%) patients in the PI and pPCI arm, respectively. At 1 year, all-cause mortality rates (6.7% versus 5.9%) were similar for PI and pPCI-treated patients (P=0.49; risk ratio, 1.13; 95% confidence interval, 0.79-1.62). Cardiac mortality rates were similar as well (4.0% versus 4.1%, P=0.93; risk ratio, 0.98; 95% confidence interval, 0.62-1.54). Overall, only 34 patients died between day 30 and 1 year, 20 in the PI arm and 14 in the pPCI arm, of whom 20 died of noncardiac reasons (13 in the PI and 7 in the pPCI arm). There was no significant difference in 1-year all-cause mortality between the 2 groups among the prespecified key subgroups. Conclusions-At 1 year, mortality rates in the PI and pPCI arms were similar in ST-segment-elevation myocardial infarction patients presenting within 3 hours after symptom onset and unable to undergo pPCI within 1 hour.
Notes: [Sinnaeve, Peter R.; Vandenberghe, Katleen; Van de Werf, Frans] Katholieke Univ Leuven, Dept Cardiovasc Sci, B-3000 Louvain, Belgium. [Armstrong, Paul W.] Univ Alberta, Canadian Virtual Coordinating Ctr Global Collabor, Canadian VIGOUR Ctr, Edmonton, AB, Canada. [Gershlick, Anthony H.] Univ Hosp Leicester Trust, Leicester Cardiovasc Biomed Res Unit, NIHR, Leicester, Leics, England. [Goldstein, Patrick] Lille Univ Hosp, Emergency Dept, Lille, France. [Goldstein, Patrick] Lille Univ Hosp, SAMU, Lille, France. [Wilcox, Robert] Univ Nottingham, Dept Cardiovasc Med, Nottingham NG7 2RD, England. [Lambert, Yves] Ctr Hosp Versailles, SAMU 78, Versailles, France. [Lambert, Yves] Ctr Hosp Versailles, Mobile Intens Care Unit, Versailles, France. [Danays, Thierry] Boehringer Ingelheim GmbH & Co KG, Reims, France. [Soulat, Louis] SAMU SMUR Urgences, Ctr Hosp Chateauroux, Chateauroux, France. [Halvorsen, Sigrun] Oslo Univ Hosp Ulleval, Dept Cardiol, Oslo, Norway. [Rosell Ortiz, Fernando] Empresa Publ Emergencias Sanitarias, Almeria, Spain. [Regelin, Anne] Univ Med Ctr Freiburg, Clin Trials Unit, Freiburg, Germany. [Bluhmki, Erich] Boehringer Ingelheim GmbH & Co KG, Biberach, Germany. [Bogaerts, Kris] Katholieke Univ Leuven, Interuniv Inst Biostat & Stat Bioinformat I BioSt, B-3000 Louvain, Belgium. [Bogaerts, Kris] Univ Hasselt, Hasselt, Belgium.
Keywords: anticoagulants; catheterization; myocardial infarction; thrombolysis, therapeutic;anticoagulants; catheterization; myocardial infarction; thrombolysis, therapeutic
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ISSN: 0009-7322
e-ISSN: 1524-4539
DOI: 10.1161/CIRCULATIONAHA.114.009570
ISI #: 000343048800007
Rights: © 2014 American Heart Association, Inc.
Category: A1
Type: Journal Contribution
Validations: ecoom 2015
Appears in Collections:Research publications

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