• Xavier Carrillo, Eduard Fernandez-Nofrerias, Oriol Rodriguez-Leor, Teresa Oliveras, Jordi Serra, Josepa Mauri, Antoni Curos, Ferran Rueda, Cosme García-García, Ricard Tresserras, Alba Rosas, Maria Teresa Faixedas, Antoni Bayes-Genis, and Codi IAM Investigators.
• Cardiology Department, H. U. Germans Trias i Pujol, Carretera de Canyet SN. 08916, Badalona, Spain Department of Medicine, Universitat Autonoma de Barcelona, Barcelona, Spain xcarrillo.germanstrias@gencat.cat xcarrillosuarez@gmail.com.
• Eur. Heart J. 2016 Apr 1; 37 (13): 1034-40.

AimsThe preferred reperfusion strategy for early ST elevation myocardial infarction (STEMI, defined as time from symptoms onset ≤120 min) in non-capable percutaneous coronary intervention (PCI) centres remains controversial. We sought to compare mortality of in situ fibrinolysis vs. PCI transfer in a real-life consecutive cohort of early STEMI.Methods And ResultsProspective multicentre STEMI registry (Catalonia 'Codi IAM' network) of all-comers in a non-capable PCI centre with symptom onset to first medical contact (FMC) <120 min. Two groups were identified: in situ fibrinolysis and transfer to a PCI-capable centre. Primary endpoint was 30-day mortality. We included 2470 patients, of whom 2227 (90.2%) and 243 (9.8%) comprised the transfer and fibrinolysis groups, respectively. In the fibrinolysis group, diagnostic and system delays were shorter (24 vs. 31 min, P < 0.001; 45 vs. 119 min, P < 0.001, respectively). Thirty-day mortality was 7.7 and 5.1% in fibrinolysis and transfer groups, respectively (P = 0.09). However, patients in the transfer group whose time FMC-device was achieved within 140 min were associated with significantly lower mortality (2.0% for FMC-device <99 min, and 4.6% for FMC-device 99-140 min; P < 0.01 and P = 0.03, respectively vs. fibrinolysis). In multivariable logistic regression analysis, reperfusion with fibrinolysis was an independent 30-day mortality predictive factor (odds ratio: 1.91, 95% confidence interval: 1.01-3.50; P = 0.04), together with age and Killip-Kimball class (both P < 0.001).ConclusionsIn early STEMI patients assisted in non-capable PCI centres, in situ fibrinolysis had worse prognosis than patient transfer. Transfer to a PCI-capable centre seems recommended in patients with FMC-device delay <140 min.Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2015. For permissions please email: journals.permissions@oup.com.

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