View source for Results of the TRANSFER AMI study published in NEJM

''June 25, 2009'': The TRANSFER-AMI Trial Investigators reported today in the ''New England Journal of Medicine'' <ref> Cantor W, Fitchett D, Borgundvaag B, Ducas J, Heffernan M, Cohen EA, Morrison LJ, Langer A, Dzavik V, Mehta SR, Lazzam C , Schwartz B, Casanova A, Goodman SJ, for the TRANSFER-AMI Trial Investigators. Routine Early Angioplasty after Fibrinolysis for Acute Myocardial Infarction. ''N. Engl. J. Med''. '''360''' (26):2705-18.</ref> that among [[ST-segment elevation myocardial infarction]] ([[STEMI]]) patients treated with [[fibrinolysis]], routine early [[adjunctive PCI]] is superior to delayed [[rescue angioplasty]]. 

While in many community hospitals without cardiac catheterization facilities fibrinolytic therapy is the standard of care <ref name="pmid18191746">{{cite journal |author=Antman EM, Hand M, Armstrong PW, ''et al.'' |title=2007 focused update of the ACC/AHA 2004 guidelines for the management of patients with ST-elevation myocardial infarction: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines |journal=J. Am. Coll. Cardiol. |volume=51 |issue=2 |pages=210–47 |year=2008 |month=January |pmid=18191746 |doi=10.1016/j.jacc.2007.10.001 |url=}}</ref>, the Trial of Routine Angioplasty and Stenting After Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI Trial) sought to investigate the safety and efficacy of transferring high risk STEMI patients to angioplasty centers within 6 hours of drug treatment. It should be noted that this was not a trial of [[facilitated PCI]]: in a trial of facilitated PCI all patients would be treated with PCI and the trial would test whether adjunctive therapy prior to the PCI improved outcomes.  This was a trial instead in which all patients received fibrinolysis, and the question was whether an early PCI could improve the outcomes with a lytic agent. PCI was performed either early in all patients (routine [[adjunctive PCI]]) or late in only those select patients who failed [[fibrinolysis]] ([[rescue angioplasty]]).

In this open label, active control, parallel assignment, safety/efficacy study, 1059 high risk [[STEMI]] patients presenting at Canadian hospitals unable to perform [[PCI]] were randomized either to immediate transfer for routine PCI within 6 hours after [[fibrinolysis]] (routine early adjunctive PCI arm, n=537) or to [[rescue PCI|rescue]] or delayed PCI only when fibrinolytic therapy failed (standard therapy arm, n=532).  Patients in both treatment strategy arms were administered [[tenecteplase]], [[aspirin]] and unfractionated [[heparin]] or [[enoxaparin]] prior at presentation in the emergency department.  The primary endpoint was a 30 day composite of all cause [[death]], re[[infarction]], recurrent [[ischemia]], [[heart failure]] or [[cardiogenic shock]].  The secondary endpoint was incidence of major/severe bleeding (according to TIMI and GUSTO classifications) within 30 days.

Compared to standard treatment, routine early [[adjunctive PCI]] was associated with an absolute reduction in the primary endpoint from 17.2% (n=90) to 11.0% (n=59), which translates to a [[relative risk reduction]] of 0.64 (95% Confidence Interval [CI]: 0.47 – 0.87, p=0.004).  Rates of TIMI major or severe GUSTO bleeding did not significantly differ between treatment strategy arms (6.1% versus 7.4% for standard and routine early PCI groups respectively, p=0.39).  While much of the benefit in the composite endpoint was driven by a reduction in recurrent ischemia, there was also a reduction in new onset heart failure. There were trends toward a benefit in [[recurrent MI]].

This trial adds to a growing body of literature that demonstrates that among patients treated with fibrinolysis for STEMI, routine, early transfer of all patients for [[adjunctive PCI]] is superior to a strategy of delayed transfer for [[rescue PCI]] among those select patients who have failed [[fibrinolysis]]. 

==Slides==
For the slides presented at ACC 2008, click [[Media:TRANSFER-AMI.ppt|here]].

==References==
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