Rationale and design of the OPTIMAL-REPERFUSION trial: A prospective randomized multi-center clinical trial comparing different fibrinolysis-transfer percutaneous coronary intervention strategies in acute ST-segment elevation myocardial infarction.

Chen, Zhongxiu, Wang, Duolao ORCID: https://orcid.org/0000-0003-2788-2464, Ma, Min, Li, Chen, Wan, Zhi, Zhang, Li, Zhu, Ye, Wang, Mian, Wang, Hua, He, Sen, Peng, Yong, Wei, Jiafu, Huang, Baotao and He, Yong (2021) 'Rationale and design of the OPTIMAL-REPERFUSION trial: A prospective randomized multi-center clinical trial comparing different fibrinolysis-transfer percutaneous coronary intervention strategies in acute ST-segment elevation myocardial infarction.'. Clinical Cardiology, Vol 44, Issue 4, pp. 455-462.

Preview

Text Rationale and design of the OPTIMAL-REPERFUSION trial - DWang.pdf - Published Version Available under License Creative Commons Attribution. Download (1MB) | Preview

Abstract

Primary percutaneous coronary intervention (PPCI), the preferred reperfusion strategy for all acute ST-segment elevation myocardial infarction (STEMI) patients, is not universally available in clinical practice. Pharmacoinvasive strategy has been proposed as a therapeutic option in patients with STEMI when timely PPCI is not feasible. However, pharmacoinvasive strategy has potential delay between clinical patency and complete myocardial perfusion. The optimal reperfusion strategy for STEMI patients with anticipated PPCI delay according to current practice is uncertain. OPTIMAL-REPERFUSION is an investigator-initiated, prospective, multicenter, randomized, open-label, superiority trial with blinded evaluation of outcomes. A total of 632 STEMI patients presenting within 6 hours after symptom onset and with an expected time of first medical contact to percutaneous coronary intervention (PCI) ≥120 minute will be randomized to a reduced-dose facilitated PCI strategy (reduced-dose fibrinolysis combined with simultaneous transfer for immediate invasive therapy with a time interval between fibrinolysis to PCI < 3 hours) or to standard pharmacoinvasive treatment. The primary endpoint is the composite of death, reinfarction, refractory ischemia, congestive heart failure, or cardiogenic shock at 30-days. Enrollment of the first patient is planned in March 2021. The recruitment is anticipated to last for 12 to 18 months and to complete in September 2023 with 1 year follow-up. The OPTIMAL-REPERFUSION trial will help determine whether reduced-dose facilitated PCI strategy improves clinical outcomes in patients with STEMI and anticipated PPCI delay. This study is registered with the ClinicalTrials.gov (NCT04752345).

Item Type:	Article
Subjects:	WG Cardiovascular System > WG 100 General works WG Cardiovascular System > WG 20 Research (General) WG Cardiovascular System > Heart. Heart Diseases > WG 200 General works WH Hemic and Lymphatic Systems > Hematologic Diseases. Immunologic Factors. Blood Banks > WH 310 Mechanism of blood coagulation. Hemostatis
Faculty: Department:	Clinical Sciences & International Health > Clinical Sciences Department
Digital Object Identifer (DOI):	https://doi.org/10.1002/clc.23582
Depositing User:	Julie Franco
Date Deposited:	09 Mar 2021 14:19
Last Modified:	28 Apr 2021 13:23
URI:	https://archive.lstmed.ac.uk/id/eprint/17215

Statistics

View details

Actions (login required)

Edit Item