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Which Early ST elevation myocardial infarction Therapy (WEST) study
Study characteristics:
- 304 patients with STEMI within 6 hours of symptom onset
All patients received aspirin 160-325 mg & enoxaparin 1 mg/kg
Groups:
1) tenecteplase (as early as possible)
2) percutaneous coronary intervention (PCI)
- clopidogrel 300 mg given prior to PCI
3) tenecteplase + invasive study within 24 hours*
* only patients with persistent symptoms or ST-segment elevation were taken to the catherization lab for PCI
Abciximab recommended for PCI group & for all PCI procedures unless within 3 hours of fibrinolysis
mean time from symptom onset to treatment:
- group 1) 112 minutes
- group 2) 112 minutes to first drug + 64 minutes to PCI
- group 3) 130 minutes
Primary composite endpoint at 30 days:
- death, reinfarction, refractory ischemia, CHF, cardiogenic shock, ventricular arrhythmia
Results:
1) primary endpoint similar in 3 groups 25%, 23%, 24%
2) combined rate of death + MI
- group 2 4%, not significantly different from group 3 7%, but significantly less than group 1 13%
General
clinical trial
References
- Armstrong PW et al,
A comparison of pharmacologic therapy with/without timely
coronary intervention vs. primary percutaneous intervention
early after ST-segment myocardial infarction: The WEST (Which
Early ST elevation myocardial infarction Therapy) study
Eur Heart J 2006, 27:1530
PMID: 16757491