Pre-hospital Administration of Thrombolytic Therapy With Urgent Culprit Artery Revascularization (PATCAR)
Heart Disease, Myocardial Infarction, Acute Myocardial Infarction
About this trial
This is an interventional treatment trial for Heart Disease focused on measuring Heart Disease, Heart Attack, Myocardial Infarction, Thrombolytic Therapy, Emergency Medicine
Eligibility Criteria
Inclusion Criteria: Ischemic discomfort (squeezing, crushing, or pressure, sub-sternal, unrelated to breathing or movement), epigastric discomfort or pre-syncopal symptoms with diaphoresis, lasting > 30 minutes. ST elevation > 0.1 mV in 2 or more contiguous limb leads or > 0.2 mV in 2 or more contiguous pre-cordial leads. Less than 6 hours after onset of sustained chest pain. Age 18 years or older. Exclusion Criteria: Chest pain described as ripping or tearing, radiating to the back and/or down the leg, and/or systolic blood pressure > 15 mmHg difference in each arm. Suspected cocaine or amphetamine use within previous 3 days. Known or suspected pregnancy. Cardiac arrest requiring intubation. Cardiac arrest requiring greater than 20 minutes CPR. Coronary intervention (PTCA/stent/CABG) within previous 4 weeks.
Sites / Locations
- Memorial Hermann Hospital / The University of Texas HSC
Arms of the Study
Arm 1
Arm 2
Arm 3
Arm 4
Experimental
Experimental
Active Comparator
Active Comparator
Group A: Full dose pre-hospital fibrinolysis
Group B: Half dose pre-hospital fibrinolysis followed by urgent PCI
Group C: Fibrinolytic ineligible patients receiving primary PCI
Group D: Patients transferred in and treated with primary PCI
Patients transported by participating EMS units and that were fibrinolytic eligible and treated with full dose, pre-hospital fibrinolysis with reteplase (treated in the ambulance with 10 units reteplase and randomized to a second 10-unit dose of reteplase).
Patients transported by participating EMS units and that were fibrinolytic eligible and treated with a half dose pre-hospital fibrinolysis with reteplase (treated in the ambulance with 10 units reteplase) and randomized to urgent catheterization with percutaneous coronary intervention (PCI).
Patients transported by participating EMS units and that were fibrinolytic ineligible and treated with primary PCI alone and that were prospectively analyzed for comparison.
Patients not transported by participating EMS units but were transferred in and treated with primary PCI alone and that were prospectively analyzed for comparison.