著者
Tomonori Itoh Ken'ichi Fukami Tomomi Suzuki Takumi Kimura Yoshinori Kanaya Makoto Orii Iwao Goto Hiroki Matsui Shoma Sugawara Satoshi Nakajima Tetsuya Fusazaki Motoyuki Nakamura for the IMPORTANT investigators
出版者
The Japanese Circulation Society
雑誌
Circulation Journal (ISSN:13469843)
巻号頁・発行日
pp.1006100756, (Released:2010-06-19)
参考文献数
27
被引用文献数
11 13

Background: Acute efficacy and long-term prognostic differences between ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (primary PCI) and those treated with pre-intervention thrombolysis combined with back-up of facilitated PCI has not been evaluated in Japanese patients. The purpose of the present study was therefore to evaluate the differences between treatment with primary PCI (primary-PCI group) and pre-treatment with tissue-type plasminogen activator (t-PA) combined with back-up of facilitated PCI (prior-t-PA group). Methods and Results: One hundred and one patients with STEMI were randomly assigned to 2 groups. Patients in the prior-t-PA group were then divided into 2 further groups, the facilitated-PCI and prior-t-PA alone groups. The patency rate at initial angiography, left ventricular ejection fraction (LVEF) at 6 months, and the major adverse cardiac event (MACE)-free rate at 5 years were then compared between the groups. The patency rate and LVEF in the prior-t-PA group was significantly higher than in the primary-PCI group (69% vs 17% respectively, P<0.001; 61.6±9.5% vs 55.0±11.6%, respectively; P=0.01). The MACE-free rate in the prior-t-PA group, however, was lower than in the primary-PCI group (58.7% vs 80.9%; P=0.03). The MACE-free rate in the facilitated-PCI group was equal to that in the primary-PCI group (73.7% vs 80.9%; P=0.39), whereas the MACE-free rate in the prior-t-PA-alone group was significantly lower than in the primary-PCI group (48.1% vs 80.9%; P=0.01). Conclusions: Primary PCI is superior to pre-intervention thrombolysis for long-term prognosis. Moreover, facilitated PCI may be as effective as primary PCI in patients with STEMI.