Review: transfer for primary angioplasty is better than immediate thrombolysis in acute myocardial infarction.

O u t c o m e s 30-day composite endpoint of all-cause mortality, reinfarction, or stroke. M a i n r e s u l t s 6 RCTs (3749 patients) met the selection criteria. Overall, transfer time was always < 3 hours. However, in 5 RCTs where data were available, the average additional time to primary PCI compared with immediate thrombolysis ranged from 70 to 103 minutes. Thrombolytic agents used included tissue plasminogen activator (4 RCTs) and streptokinase (2 RCTs). Meta-analyses were done using both fixed and random-effects models because of clinical heterogeneity between the RCTs. Both analyses showed that the rates of the composite endpoint, reinfarction, and stroke were lower in the PCI group than in the immediate-thrombolysis group (Table). The groups did not differ for all-cause mortality (Table).