Outcomes of 669 STEMI patients (< 12 h chest pain, non shock, fibrinolysis eligible, < 75 years) with transfer delay to PCI > 90 min who received half-dose alteplase and full-dose abciximab and were immediately transferred for PCI were compared with primary PCI effects in 1311 patients with transfer delay < 90 min. Mean time from symptom-onset to PCI was longer (357 ± 145 min vs. 201 ± 177; P < 0.001) in facilitated PCI with reduced-dose fibrinolysis group. In-hospital and 12-month outcomes were similar in both groups, however bleeding events were more frequent in facilitated PCI group (hemorrhagic stroke 0.9 % vs. 0 % ; P < 0.001; severe + moderate 5.5 % vs. 2.3 % ; P < 0.001).
This is the first large report showing the safety and benefits of transportation with very long transfer delay (> 90 min) for facilitated PCI with reduced-dose fibrinolysis in STEMI patients. In fact, pharmacological treatment (combotherapy) was effective in overcoming the deleterious effects of long time-delay on outcome, with similar survival as compared to short-time transportation, despite higher risk of major bleeding complication.