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Early Percutaneous Coronary Intervention (PCI) After Fibrinolysis Versus Standard Therapy in ST Segment Elevation Myocardial Infarction (STEMI) Patients

The recruitment status of this study is unknown. The completion date has passed and the status has not been verified in more than two years.
Verified November 2009 by Royal Brompton & Harefield NHS Foundation Trust.
Recruitment status was:  Recruiting
Information provided by:
Royal Brompton & Harefield NHS Foundation Trust Identifier:
First received: November 13, 2009
Last updated: NA
Last verified: November 2009
History: No changes posted

Several recent trials (1,2) suggest that all STEMI patients receiving fibrinolysis in non-PCI centres should be routinely transferred for elective early PCI within 24 hours from hospitalization, with no additive risk of major bleeding complications or other severe adverse events compared standard therapy. These results in favour of a routine invasive strategy in STEMI patients suggest a potential change to the current approach of awaiting the response to treatment in patients receiving fibrinolysis, and draw the attention to the potential need for an appropriate network organization with adequate first hospitalization treatment (spoke) and prompt transfer to centres with 24/7 PCI capabilities (hub). The recent ESC (3) and ACC (4) guidelines on STEMI are consistent with the early ESC PCI Guidelines, recommending that angioplasty after fibrinolysis should be performed within a time-window ranging between 3 and 24 hours after successful lytic administration (level evidence IIA). The reason for the weighting of the recommendation is due to the heterogeneity of trial results with different planned-revascularization strategies, variable primary end-points definitions, and small individual trial sample sizes. Therefore, a consistent analysis of single patient dataset from all published randomized trials would be of value to better define the magnitude and duration of clinical benefit of the routine invasive strategy after lytic treatment as well as the potential optimal timing of such a strategy.

The main aim of the OTTER meta-analysis is to define the benefits of immediate PCI after fibrinolysis for STEMI patients. Moreover, the OTTER meta-analysis will investigate the optimal timing of post-fibrinolysis elective revascularization.

Myocardial Infarction

Study Type: Observational
Official Title: Early Invasive Strategy After Fibrinolysis vs Standard Management in STEMI Patients: Results From an Individual Patient Data Meta-analysis (OTTER Meta-analysis) OTTER: Optimal Timing for Post-Thrombolysis Elective Revascularization

Resource links provided by NLM:

Further study details as provided by Royal Brompton & Harefield NHS Foundation Trust:

Primary Outcome Measures:
  • Combined death/reinfarction [ Time Frame: 30 days ]

Secondary Outcome Measures:
  • Death, reinfarction, recurrent ischemia and urgent revascularization [ Time Frame: 30 days ]
  • Combined death/reinfarction/recurrent ischemia/urgent revascularization and new presentation CHF and shock [ Time Frame: 30 days. ]
  • Major bleeding and hemorrhagic stroke [ Time Frame: 30 days ]
  • Combined death/reinfarction and combined revascularization/recurrent ischemia [ Time Frame: 6-12 months ]
  • Influence of Optimal Timing of Post-Thrombolysis early revascularization on primary and secondary clinical end-points [ Time Frame: 0-24 hours from thrombolysis ]

Estimated Enrollment: 3000
Study Start Date: November 2009
Estimated Study Completion Date: December 2009
Estimated Primary Completion Date: December 2009 (Final data collection date for primary outcome measure)
Early PCI
Routine invasive strategy with early PCI performed in STEMI patients within 24 hours from successful fibrinolysis
Standard Therapy
Standard therapy in STEMI patients with fibrinolysis and/or conventional ischaemic-guided therapy.

  Show Detailed Description


Ages Eligible for Study:   Child, Adult, Senior
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   No
Sampling Method:   Non-Probability Sample
Study Population
STEMI patients.

Inclusion Criteria:

  • STEMI patients enrolled within 12 hours from onset of symptoms
  • Controlled randomized trials comparing a routine invasive strategy with standard therapy in STEMI patients
  • Modern fibrin-specific therapy in both groups
  • Stenting PCI > 80% of invasive procedures
  • English language

Exclusion Criteria:

  • Cardiogenic shock at presentation
  • Need for concomitant
  • Major surgery
  • Severe chronic renal or hepatic impairment
  • Myocardial infarction within the previous 2 weeks
  • Contraindications to thrombolytic therapy, abciximab, aspirin, or clopidogrel
  • Non randomized trials
  • Single patient data not available
  • Non fibrin-specific lytic therapy
  • Stenting PCI < 80% of invasive procedures
  • Not English language
  Contacts and Locations
Choosing to participate in a study is an important personal decision. Talk with your doctor and family members or friends about deciding to join a study. To learn more about this study, you or your doctor may contact the study research staff using the Contacts provided below. For general information, see Learn About Clinical Studies.

Please refer to this study by its identifier: NCT01014182

Contact: Carlo Di Mario, MD 0044 20 7351 ext 8616

United Kingdom
Royal Brompton Hospital Recruiting
London, United Kingdom, SW6 3NP
Contact: Carlo Di Mario    0044 20 7351 ext 8616   
Sponsors and Collaborators
Royal Brompton & Harefield NHS Foundation Trust
  More Information

Publications automatically indexed to this study by Identifier (NCT Number):
Responsible Party: Prof.Carlo Di Mario, Royal Brompton & Harefield NHS Foundation Trust Identifier: NCT01014182     History of Changes
Other Study ID Numbers: OTTER220179
Study First Received: November 13, 2009
Last Updated: November 13, 2009

Keywords provided by Royal Brompton & Harefield NHS Foundation Trust:
Early PCI
Myocardial Infarction
Optimal revascularization therapy in STEMI patients

Additional relevant MeSH terms:
Myocardial Infarction
Pathologic Processes
Myocardial Ischemia
Heart Diseases
Cardiovascular Diseases
Vascular Diseases processed this record on August 23, 2017