Open AccessRationale 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
Author(s) -
Chen Zhongxiu,
Wang Duolao,
Ma Min,
Li Chen,
Wan Zhi,
Zhang Li,
Zhu Ye,
Wang Mian,
Wang Hua,
He Sen,
Peng Yong,
Wei Jiafu,
Huang Baotao,
He Yong
Publication year - 2021
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.23582
Subject(s) - medicine , fibrinolysis , percutaneous coronary intervention , conventional pci , myocardial infarction , cardiology , cardiogenic shock , clinical endpoint , randomized controlled trial , reperfusion therapy , fibrinolytic agent , surgery , tissue plasminogen activator
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).