Long-term follow-up of the Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI)

Background — The Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) demonstrated superiority of routine early coronary angiography (and percutaneous coronary intervention [PCI]) compared to standard therapy in fibrinolytic-treated ST-segment elevation myocardial infarction (STEMI) patients at 30 days. The aim of the present study was to evaluate the long term (>7 year) effects of an early invasive strategy.

Methods — We linked the study cohort and administrative datasets to assess long term follow-up status including repeat procedures, hospitalizations, and major adverse cardiovascular events (MACE). Kaplan-Meier and Cox regression analysis were used to evaluate the relationship between randomized treatment and long-term adverse outcomes.

Results — A total of 881 patients had long-term follow-up and were included in our study. After a mean follow-up of 7.8 years, there were no significant differences in death, myocardial infarction (MI), unstable angina, stroke, transient ischemic attack (TIA), or heart failure admissions (HR 0.91 [95% CI 0.73-1.13]; p=0.41) between those randomized to an early invasive vs. standard treatment strategy. Following the index hospitalization, there were no significant differences in the rates of coronary revascularization between the early invasive and the standard therapy groups (81 [19.3%] vs. 76 [17.9%]; p=0.61).

Conclusion — Despite the short-term benefit and safety of an early invasive strategy in STEMI patients receiving fibrinolysis, no statistically-significant differences in MACE were observed over 7.8 years.