Efficacy of an Early Invasive Strategy After Fibrinolysis in ST-Elevation XXXX Relative to the Extent of Coronary Artery Disease.

@entity1 @entity712 @entity66 @entity63 @entity1188 @entity583 @entity204
BACKGROUND: A strategy of early transfer for coronary angiography and intervention is superior to a standard approach of delayed coronary angiography after fibrinolysis for @entity583 ( @entity583 ). @entity583 @entity1 with lesions in noninfarct-related arteries have a worse prognosis compared with @entity1 with @entity66 . This study aimed to assess whether the benefits of an early invasive strategy differ in @entity1 with single vessel and multivessel disease. METHODS: The Trial of Routine ANgioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute @entity583 (TRANSFER-AMI) randomized @entity583 @entity1 receiving fibrinolysis to a strategy of early transfer and coronary angiography vs a standard approach. In this post hoc analysis, we stratified 992 @entity1 into 2 groups according to the presence or absence of multivessel disease. We compared the 2 groups in terms of baseline characteristics, in-hospital management, and @entity1 outcomes, and tested for treatment heterogeneity. RESULTS: Multivessel disease was present in 369 (37%) @entity1 . @entity1 with multivessel disease had a greater rate of the primary composite end point of in-hospital @entity204 , recurrence of @entity1188 , recurrent @entity63 , shock, or @entity712 at 30 days (18.2% vs 10.8%; P < 0.001). An early invasive strategy was efficacious in both groups for the primary outcome. In multivariable analysis adjusting for Global Registry of Acute Coronary Events (GRACE) risk score, there was no significant treatment heterogeneity (all P interaction > 0.40) for the primary end point, or @entity204 /recurrence of @entity1188 at 6 months and 1 year. CONCLUSIONS: Multivessel disease is present in a significant proportion of @entity583 @entity1 treated with fibrinolysis and is associated with worse outcomes. A strategy of early transfer and coronary intervention after fibrinolysis was beneficial regardless of the presence or absence of multivessel disease.
