News:Early Transfer of AMI Patients for PCI improves cardiovascular outcomes in the TRANSFER-AMI study

March 30, 2008 By Alexandra M. Palmer [mailto:apalmer@perfuse.org]

The goal of the TRANSFER-AMI (Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction) trial was to evaluate the safety and efficacy of the pharmaco-invasive strategy (transfer to a PCI center for routine early PCI within 6 hrs of fibrinolysis) in comparison to a standard treatment regimen including catheterization at 24 hours following fibrinolysis and transferring patients to a PCI center only in the case of failed reperfusion.

The authors hypothesized that using this method to minimize the time between the administration of fibrinolytic therapy and adjunctive angioplasty would result in reduced rates of death, heart failure, recurrent ischemia, shock and reinfarction at 30 days. This information was presented by Dr. Warren J. Cantor at the SCAI-i2 summit Annual Scientific Sessions in Chicago today.

The TRANSFER-AMI trial was a randomized, open label, active control, safety/efficacy study which enrolled 1,060 patients at centers in Canada as of December 31, 2007. The inclusion criteria included STEMI (ST elevation myocardial infarction) patients at least 18 years of age who arrived at a treatment center that does not perform PCI within 12 hrs of symptom onset having had more than 30 minutes of continuous STEMI symptoms.

Patients were eligible if they presented with either ST-segment elevation ≥ 2 mm in 2 or more contiguous anterior leads or ST-segment elevation ≥ 1 mm in 2+ inferior leads with at least one of the following: ≥ 2 mm ST-segment depression in anterior leads, ≥ 1 mm ST-elevation in right-sided lead V4 (V4R), heart rate >100 / minute, Killip Class II-III, systolic blood pressure < 100 mm Hg. Patients entered in the trial were randomized to either of two arms: standard treatment after fibrinolysis (n=508) or immediate transfer for routine PCI within 6 hours after fibrinolysis (n=522).

There was a significant reduction in the primary endpoint (combined 30-day death, reinfarction, heart failure, severe recurrent ischemia, shock) in the transfer group compared to the standard group [10.6% vs. 16%, OR=0.537 (0.368, 0.783); p=0.0013). This was primarily due to reduction in reinfarction (6% vs. 3.3%, p=0.044) and recurrent ischemia (2.2% vs. 0.2%, p=0.019). This benefit was not associated with increased bleeding risk (TIMI major bleed 4.6% vs. 4.3%, p=0.88).

The investigators concluded that for high-risk STEMI patients receiving fibrinolysis at non-PCI centers, urgent transfer and PCI within 6 hours is associated with significantly less ischemic complications and no excess in bleeding.

This trial was supported by the Canadian Heart Research Center.