Methods:

This was a post-hoc subgroup analysis of Trial of Routine Angioplasty and Stenting after Fibrinolysis to Enhance Reperfusion in Acute Myocardial Infarction (TRANSFER-AMI) patients who were stratified by the GRACE risk score. In TRANSFER-AMI, 1,059 patients with acute STEMI who received tenecteplase in 53 Canadian hospitals were randomized to standard medical treatment (rescue PCI if required or delayed coronary angiography) versus immediate transfer for PCI within 6 hours of fibrinolysis. Eligibility requirements included admission for anterior or inferior STEMI with other high-risk features including tachycardia, hypotension, Killip class II-III, or electrocardiogram evidence of posterior or right ventricular involvement. Major exclusion criteria included cardiogenic shock (before enrollment), previous PCI within the past month, previous coronary artery bypass grafting, or availability of timely PCI. For each patient, a GRACE risk score was calculated based on age, heart rate, systolic blood pressure, Killip class, cardiac arrest, ST-segment deviation, abnormal biomarkers, and serum creatinine. Since data regarding cardiac arrest on admission were not collected, and this is a variable included in the GRACE risk score, the investigators used in-hospital arrest instead. The primary outcome of interest was death or re-MI at 30 days.