Forum for Science, Industry and Business

Sponsored by:     3M 
Search our Site:

 

Results from NORDISTEMI

01.09.2009
By Associate Professor Sigrun Halvorsen

NORDISTEMI: first trial to study the effect of early PCI after fibrinolysis in rural areas with very long transfer delays.

Results from the NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction (NORDISTEMI) show that patients presenting with acute ST-elevation myocardial infarction (STEMI) in rural areas have a better treatment outcome with thrombolysis followed by immediate transfer for angiography than with thrombolysis and conservative, community-hospital follow-up.

The latest European guidelines on the treatment of STEMI put emphasis on speedy reperfusion therapy, performed by "percutaneous coronary interventions" (PCI, with balloon angioplasty and stent) and thrombolysis. Primary PCI is the preferred treatment if available within two hours of first medical contact. If PCI is not possible within two hours, the guidelines advise that pre- or in-hospital thrombolysis should be performed as soon as possible. In addition, transfer for angiography and PCI after thrombolysis is recommended, but the role and timing of early PCI after thrombolysis have not been established for patients living in rural areas with very long transfers. Which reperfusion strategy would be most effective in these cases?

NORDISTEMI is the first trial to study the effect of early PCI after fibrinolysis in rural areas with very long transfer delays. The median transfer distance to PCI was 158 km, and median transfer time was 130 minutes. Thrombolysis was given as pre-hospital treatment in 58% of patients; adjunctive anti-thrombotic medication was in accordance with the latest European guidelines. The results of the study suggest that in areas with long transfer delays an early invasive strategy (with angiography following thrombolysis) might be preferable to a more conservative approach.

About the study

The NORDISTEMI was a randomised, open, multicentre study conducted in Norway between February 2005 and April 2009. It compared two different strategies after fibrinolysis in a region with long transfer distances to PCI (100-400 km): to transfer all patients for immediate coronary angiography and intervention, or to manage the patients more conservatively.

A total of 266 STEMI patients, aged 18-75 years, received thrombolytic therapy and were randomised to either immediate transfer for angiography/PCI or to standard management in the community hospitals with urgent transfer only for a rescue indication or with clinical deterioration. All patients received aspirin, tenecteplase, enoxaparin and clopidogrel as anti-thrombotic medication.

Results

The results showed a reduction in the primary composite endpoint of death, reinfarction, stroke or new ischemia within 12 months in the early invasive group, but the reduction did not reach statistical significance (hazard ratio 0.72, 95% CI 0.44-1.18, p=0.19). However, the composite of death, reinfarction or stroke at 12 months was significantly reduced in the early invasive group compared to the conservative group (6.0% versus 15.9%, hazard ratio 0.36, 95% CI 0.16-0.81, p=0.01). No significant differences in bleeding or infarct size were observed, and transfer-related complications were few.

Says associate professor Sigrun Halvorsen, the principal investigator of the study: "Our study indicates a potential for improving reperfusion strategies for patients living in rural areas with long transport distances. This may be achieved by applying a well-organised pharmaco-invasive approach, including pre-hospital thrombolysis and rapid transfer to a PCI centre".

Jacquelline Partarrieu | EurekAlert!
Further information:
http://www.escardio.org

More articles from Studies and Analyses:

nachricht Win-win strategies for climate and food security
02.10.2017 | International Institute for Applied Systems Analysis (IIASA)

nachricht The personality factor: How to foster the sharing of research data
06.09.2017 | ZBW – Leibniz-Informationszentrum Wirtschaft

All articles from Studies and Analyses >>>

The most recent press releases about innovation >>>

Die letzten 5 Focus-News des innovations-reports im Überblick:

Im Focus: Neutron star merger directly observed for the first time

University of Maryland researchers contribute to historic detection of gravitational waves and light created by event

On August 17, 2017, at 12:41:04 UTC, scientists made the first direct observation of a merger between two neutron stars--the dense, collapsed cores that remain...

Im Focus: Breaking: the first light from two neutron stars merging

Seven new papers describe the first-ever detection of light from a gravitational wave source. The event, caused by two neutron stars colliding and merging together, was dubbed GW170817 because it sent ripples through space-time that reached Earth on 2017 August 17. Around the world, hundreds of excited astronomers mobilized quickly and were able to observe the event using numerous telescopes, providing a wealth of new data.

Previous detections of gravitational waves have all involved the merger of two black holes, a feat that won the 2017 Nobel Prize in Physics earlier this month....

Im Focus: Smart sensors for efficient processes

Material defects in end products can quickly result in failures in many areas of industry, and have a massive impact on the safe use of their products. This is why, in the field of quality assurance, intelligent, nondestructive sensor systems play a key role. They allow testing components and parts in a rapid and cost-efficient manner without destroying the actual product or changing its surface. Experts from the Fraunhofer IZFP in Saarbrücken will be presenting two exhibits at the Blechexpo in Stuttgart from 7–10 November 2017 that allow fast, reliable, and automated characterization of materials and detection of defects (Hall 5, Booth 5306).

When quality testing uses time-consuming destructive test methods, it can result in enormous costs due to damaging or destroying the products. And given that...

Im Focus: Cold molecules on collision course

Using a new cooling technique MPQ scientists succeed at observing collisions in a dense beam of cold and slow dipolar molecules.

How do chemical reactions proceed at extremely low temperatures? The answer requires the investigation of molecular samples that are cold, dense, and slow at...

Im Focus: Shrinking the proton again!

Scientists from the Max Planck Institute of Quantum Optics, using high precision laser spectroscopy of atomic hydrogen, confirm the surprisingly small value of the proton radius determined from muonic hydrogen.

It was one of the breakthroughs of the year 2010: Laser spectroscopy of muonic hydrogen resulted in a value for the proton charge radius that was significantly...

All Focus news of the innovation-report >>>

Anzeige

Anzeige

Event News

ASEAN Member States discuss the future role of renewable energy

17.10.2017 | Event News

World Health Summit 2017: International experts set the course for the future of Global Health

10.10.2017 | Event News

Climate Engineering Conference 2017 Opens in Berlin

10.10.2017 | Event News

 
Latest News

Terahertz spectroscopy goes nano

20.10.2017 | Information Technology

Strange but true: Turning a material upside down can sometimes make it softer

20.10.2017 | Materials Sciences

NRL clarifies valley polarization for electronic and optoelectronic technologies

20.10.2017 | Interdisciplinary Research

VideoLinks
B2B-VideoLinks
More VideoLinks >>>