1-year survival in a randomized trial of facilitated reperfusion: results from the FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) trial.

Published

Journal Article

OBJECTIVES: The aim of this report was to evaluate 12-month outcomes of facilitated percutaneous coronary intervention (PCI) in the FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) trial. BACKGROUND: Treatment delays remain common for patients with primary PCI leading to studies evaluating possible benefit of "facilitated" PCI. In the FINESSE trial, no reduction in the 90-day primary ischemic end point and an increase in bleeding were observed with both facilitated approaches, although modest favorable trends were seen for some patient subgroups. METHODS: A total of 2,452 patients with ST-segment elevation myocardial infarction (MI) and anticipated 1 to 4 h delay until catheterization were randomized to reduced-dose reteplase + abciximab, abciximab alone, or placebo, followed by expedited primary PCI. Placebo-treated patients received abciximab in the cath lab. One-year mortality was a pre-specified secondary end point. RESULTS: One-year mortalities in the 3 groups noted in the preceding text were 6.3%, 7.4%, and 7.0%, respectively (p = NS), representing 1.1%, 1.9%, and 2.5% increments since the 90-day outcome (p = 0.053 for combination treatment vs. primary PCI). A favorable trend with combination treatment was seen for patients with anterior MI (p = 0.09), but no other specified groups benefited or tended to benefit. Independent baseline correlates of 1-year mortality were systolic blood pressure <100 mm Hg, prior MI, age, Killip class >1, anterior MI, body mass index < or =25 kg/m(2), heart rate >100 beats/min, and no statin use. CONCLUSIONS: These results suggest that widespread utilization of the facilitated approaches tested cannot be justified, but that high-risk patient groups such as patients with anterior MI may deserve further study. (The FINESSE trial; NCT00046228).

Full Text

Duke Authors

Cited Authors

  • Ellis, SG; Tendera, M; de Belder, MA; van Boven, AJ; Widimsky, P; Andersen, HR; Betriu, A; Savonitto, S; Adamus, J; Peruga, JZ; Hamankiewicz, M; Pluta, W; Oldroyd, K; Ecollan, P; Janssens, L; Armstrong, P; Brodie, BR; Herrmann, HC; Montalescot, G; Neumann, F-J; Effron, MB; Barnathan, ES; Topol, EJ; FINESSE Investigators,

Published Date

  • October 2009

Published In

Volume / Issue

  • 2 / 10

Start / End Page

  • 909 - 916

PubMed ID

  • 19850248

Pubmed Central ID

  • 19850248

Electronic International Standard Serial Number (EISSN)

  • 1876-7605

Digital Object Identifier (DOI)

  • 10.1016/j.jcin.2009.07.009

Language

  • eng

Conference Location

  • United States