Inter-hospital transport for primary angioplasty does not compromise left ventricular function: six-month echocardiographic follow-up of the PRAGUE 1 Study.

ABSTRACT

The main aim of the present study was to investigate whether long distance interhospital transport for primary angioplasty (delayed mechanical reperfusion) influences the resulting left ventricular function after myocardial infarction as compared with thrombolysis at the nearest hospital (immediate pharmacological reperfusion). Primary coronary angioplasty is more effective than thrombolysis in restoring coronary flow in patients with acute myocardial infarction. It is not known whether a delay in reperfusion due to transport to an angioplasty centre compromises left ventricular function, and whether combination therapy (ie, thrombolysis during transport to an angioplasty centre) would help preserve ejection fraction. The "PRAGUE-1" Study randomised 300 patients with myocardial infarction admitted to community hospitals without a cath-lab into 3 groups group A (thrombolysis, no transport, n = 99), group B (thrombolysis during transport to an angioplasty centre, n = 100), and group C (transport for primary angioplasty, n = 101). Transport distances were below 75 kilometres, and mean transport time was 38 minutes. This paper presents for the first time the echocardiographic data from the early (discharge, day 30) and mid-term (6 months) follow-up. Only patients who survived until discharge (A 85, B 88, C 94) could be analysed. Ejection fraction improved between discharge and 6 months (P < 0.01) in all three groups from 47% to 51% in group A, from 47% to 52% in group B, and from 48% to 52% in group C. The differences between the groups were not significant. The same differences were found for the wall motion score index. Left ventricular end-diastolic diameter did not differ between the groups/examinations. Greater improvement was documented in the period between hospital discharge and day 30, compared to the period between day 30 and 6 months. The time delay associated with an inter-hospital transport strategy for primary angioplasty did not compromise left ventricular function. The strategy of thrombolysis during transport did not further improve left ventricular function compared to transport for primary angioplasty alone.