Which Early ST elevation myocardial infarction Therapy (WEST) study

Introduction

Study characteristics:

• 304 patients with STEMI within 6 hours of symptom onset

All patients received aspirin 160-325 mg & enoxaparin 1 mg/kg

Groups:

• tenecteplase (as early as possible)
• percutaneous coronary intervention (PCI)
  • clopidogrel 300 mg given prior to PCI
• 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:

• primary endpoint similar in 3 groups 25%, 23%, 24%
• combined rate of death + MI
  • group 2 4%, not significantly different from group 3 7%, but significantly less than group 1 13%

More general terms

• clinical trial