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Vol. 70. Issue 10.
Pages 888 (October 2017)
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Vol. 70. Issue 10.
Pages 888 (October 2017)
Letter to the Editor
DOI: 10.1016/j.rec.2017.06.025
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Reperfusion Strategies in Hospitals Without Primary Percutaneous Coronary Intervention. Response
Estrategias de reperfusión en hospitales sin intervención coronaria percutánea primaria. Respuesta
Antoni Carol Ruiza,
Corresponding author

Corresponding author:
, Josep Masip Utsetb, Albert Ariza-Soléc
a Servicio de Cardiología, Unidad de Hospitalización, Hospital Moisés Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Barcelona, Spain
b Servicio de Medicina Intensiva, Hospital Moisés Broggi, Consorci Sanitari Integral (CSI), Sant Joan Despí, Barcelona, Spain
c Servicio de Cardiología, Unidad de Cuidados Agudos Cardiológicos, Hospital Universitario de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
Related content
Rev Esp Cardiol. 2017;70:88710.1016/j.rec.2017.05.031
Fernando Rosell-Ortiz, Francisco J. Mellado Vergel, Javier García del Águila
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To the Editor,

We appreciate the comments by Rosell-Ortiz et al. Indeed, half the patients in our study required transfer between centers for primary angioplasty with the associated delay that this entails.1 Although some randomized studies have shown noninferiority of fibrinolysis therapy in the first few hours after ST-elevation myocardial infarction compared with primary angioplasty,2 in general, primary angioplasty is superior, given its greater reperfusion efficacy and lower frequency of complications and bleeding complications in particular.3 Another recent analysis of patients treated according to the Codi Infart protocol within 2hours of infarction also reported that primary angioplasty was superior to fibrinolysis, except when the delay from first medical contact to reperfusion exceeded 140minutes.4

The Codi Infart protocol includes administration of fibrinolysis when the delay between first medical contact and reperfusion is expected to be longer than 120minutes on the basis of availability of a catheterization laboratory, number of ambulances, and traffic in the area. This strategy is also used in other consolidated care systems such as that in Asturias, with a different orography to that in Catolonia, although also with excellent results.5 The geography of Catalonia is not complex, which usually allows primary angioplasty within the recommended timeframe. Fibrinolysis (and subsequent transfer to a referral hospital with a catheterization laboratory) is reserved for situations when the timeframe is truly unrealistic (that is, centers a very long way from the referral hospital). This suggests that most delays could be shortened by much earlier diagnosis and drainage after first contact.



We thank all the health care professionals involved in the Codi Infart program.

A. Carol Ruiz, J. Masip Utset, A. Ariza Solé.
Predictors of late reperfusion in STEMI patients undergoing primary angioplasty. Impact of the place of first medical contact.
Rev Esp Cardiol., 70 (2017), pp. 162-169
P. Armstrong, A. Gershlick, P. Goldstein, et al.
Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction.
N Engl J Med., 368 (2013), pp. 1379-1387
E. Keeley, J. Boura, C. Gines.
Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials.
X. Carrillo, E. Fernández-Nofrerías, O. Rodríguez-Leor, et al.
Early ST elevation myocardial infarction in non-capable percutaneous coronary intervention centres:in situ fibrynolisis vs. percutaneous coronary intervention transfer.
Eur Heart J., 37 (2016), pp. 1034-1040
I. Lozano, A. Suárez-Cuervo, J. Rondán, et al.
Care network for ST–elevation myocardial infarction: what is the ideal catchment area for primary angioplasty?.
Rev Esp Cardiol., 68 (2015), pp. 444-445
Copyright © 2017. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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