***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background — The Danish Acute Myocardial Infa rct ion 2 ( DANAMI-2 ) study found that primary angioplasty ( primary percutaneous coronary intervention [ pPCI ] ) compared with fibrinolysis reduced 30-day adverse events in patients with ST-segment elevation myocardial infa rct ion . The present study investigated whether the benefit of pPCI was maintained at a long-term follow-up . Methods and Results — We r and omly assigned 1572 patients with ST-segment elevation myocardial infa rct ion—1129 patients at referral hospitals and 443 patients at invasive hospitals — to pPCI or fibrinolysis . Median time from r and omization to arrival in the catheterization laboratory for patients admitted to referral hospitals was 67 minutes , with 96 % of patients arriving in the catheterization laboratory within 120 minutes . The primary study end point was a composite of death or reinfa rct ion . Median follow-up time was 7.8 years . For the primary end point , 8-year cumulative incidence ( 1-Kaplan – Meier ) was 34.8 % in the pPCI group and 41.3 % in the fibrinolysis group ( hazard ratio , 0.78 ; 95 % confidence interval , 0.66 to 0.92 ) . Reinfa rct ion rates were reduced in the pPCI group ( 11.7 % versus 18.5 % ; hazard ratio , 0.60 ; 95 % confidence interval , 0.46 to 0.77 ) . Among patients r and omized at referral hospitals , pPCI reduced reinfa rct ion ( 13 % versus 18.5 % ; hazard ratio , 0.66 ; 95 % confidence interval , 0.49 to 0.89 ) and mortality ( 26.7 % versus 33.3 % ; hazard ratio , 0.78 ; 95 % confidence interval , 0.63 to 0.97 ) . Conclusions — The benefit of pPCI over fibrinolysis was maintained at a long-term follow-up . pPCI reduced the risk of reinfa rct ion in the overall cohort and reduced reinfa rct ion and mortality among patients r and omized at referral hospitals . This result reinforces that pPCI should be offered to ST-segment elevation myocardial infa rct ion patients when interhospital transport to an invasive hospital can be completed within 120 minutes BACKGROUND Prevention of myocardial damage is the main goal of all reperfusion therapies in patients with acute myocardial infa rct ion . The relative efficacy of various reperfusion strategies is under intensive investigation . We assessed whether coronary stenting combined with the blockade of platelet glycoprotein IIb/IIIa receptors produces a greater degree of myocardial salvage than fibrinolysis with an accelerated infusion of alteplase , a tissue plasminogen activator , in patients with acute myocardial infa rct ion . METHODS A total of 140 patients were enrolled in the r and omized trial ; 71 were assigned to receive a stent plus abciximab , and 69 to receive intravenous alteplase . The primary end point was the degree of myocardial salvage , determined by means of serial scintigraphic studies with technetium Tc 99 m sestamibi . The secondary end point was a composite of death , reinfa rct ion , and stroke within six months after r and omization . RESULTS In the group that received a stent plus abciximab , the median size of the final infa rct was 14.3 percent of the left ventricle ( 25th and 75th percentiles , 6.8 and 24.5 percent ) , as compared with a median of 19.4 percent ( 25th and 75th percentiles , 7.9 and 34.2 percent ) in the alteplase group ( P=0.02 ) . This difference was due to the larger salvage index ( the percentage of the left ventricle that was salvaged , divided by the percentage that was compromised by the initial perfusion defect ) in the stent group : 0.57 ( 25th and 75th percentiles , 0.35 and 0.69 ) , as compared with 0.26 ( 25th and 75th percentiles , 0.09 and 0.61 ; P<0.001 ) . The cumulative incidence of death , reinfa rct ion , or stroke at six months was lower in the stent group than in the alteplase group ( 8.5 vs. 23.2 percent . P=0.02 ; relative risk , 0.34 ; 95 percent confidence interval , 0.13 to 0.88 ) . CONCLUSIONS In patients with acute myocardial infa rct ion , coronary stenting plus abciximab leads to a greater degree of myocardial salvage and a better clinical outcome than does fibrinolysis with a tissue plasminogen activator OBJECTIVES The purpose of this study was to examine the incidence and implication s of recurrent ischemia after different reperfusion strategies in acute myocardial infa rct ion . BACKGROUND The rates and effects of recurrent ischemia after reperfusion with thrombolytic therapy and with primary percutaneous transluminal coronary angioplasty have not been compared . METHODS At 12 centers 395 patients presenting within 12 h of the onset of acute myocardial infa rct ion were prospect ively r and omized to receive recombinant tissue-type plasminogen activator ( rt-PA ) or primary coronary angioplasty . Sixteen clinical variables were examined by using univariate and multiple logistic regression analysis to identify the predictors of recurrent ischemia . The relation of recurrent ischemic events to patient outcome was analyzed . RESULTS Recurrent ischemia developed in 76 patients ( 19.2 % ) before hospital discharge , result ing in reinfa rct ion in 18 patients ( 4.6 % ) and death in 5 ( 2.6 % ) . Recurrent ischemia occurred in 56 patients ( 28.0 % ) after rt-PA but in only 20 patients ( 10.3 % ) after coronary angioplasty ( p < 0.0001 ) , directly contributing to a higher rate of death or reinfa rct ion ( 7.5 % vs. 3.1 % , p = 0.05 ) , catheterization and revascularization procedures and prolonged hospital stay after thrombolysis . By multivariate analysis , treatment with coronary angioplasty rather than rt-PA was the strongest predictor of freedom from recurrent ischemia . Although the incidence of recurrent ischemia after angioplasty and after rt-PA was similar within the 1st 2 days of admission ( 9.2 % vs. 14.5 % , p = 0.11 ) , after hospital day 2 recurrent ischemia occurred in only 2 patients who received primary angioplasty compared with 27 patients who received rt-PA ( 1.1 % vs. 13.5 % , p < 0.0001 ) . CONCLUSIONS The development of recurrent ischemia adversely affects patient outcome , increasing morbidity , mortality and re source utilization . The much lower rate of recurrent ischemia after primary coronary angioplasty than after rt-PA results in improved survival without reinfa rct ion and allows a shorter , less complicated hospital stay . Given the extremely low rate of recurrent ischemia after hospital day 2 , safe early discharge on day 3 after primary coronary angioplasty should be feasible in selected patients with acute myocardial infa rct ion BACKGROUND Although both prehospital fibrinolysis and primary angioplasty provide a clinical benefit over in-hospital fibrinolysis in acute myocardial infa rct ion , they have not been directly compared . Our aim was to find out whether primary angioplasty was better than prehospital fibrinolysis . METHODS We did a r and omised multicentre trial of 840 patients ( of 1200 planned ) who presented within 6 h of acute myocardial infa rct ion with ST-segment elevation , initially managed by mobile emergency-care units . We assigned patients to  prehospital fibrinolysis ( n=419 ) with accelerated alteplase or primary angioplasty ( n=421 ) , and transferred all to a centre with access to emergency angioplasty . Our primary endpoint was a composite of death , non-fatal reinfa rct ion , and non-fatal disabling stroke at 30 days . Analyses were by intention to treat . FINDINGS The median delay between onset of symptoms and treatment was 130 min in the prehospital-fibrinolysis group and 190 min ( time to first balloon inflation ) in the primary -angioplasty group . Rescue angioplasty  was done in 26 % of the patients in the fibrinolysis group . The rate of the primary endpoint was 8.2 % ( 34 patients ) in the prehospital-fibrinolysis group and 6.2 % ( 26 patients ) in the primary -angioplasty group ( risk difference 1.96 , 95 % CI -1.53 to 5.46 ) . 16 ( 3.8 % ) patients assigned prehospital fibrinolysis and 20 ( 4.8 % ) assigned primary angioplasty  died ( p=0.61 ) . INTERPRETATION A strategy of primary angioplasty was not better than a strategy of prehospital fibrinolysis ( with transfer to an interventional facility for possible rescue angioplasty ) in patients presenting with early myocardial infa rct ion OBJECTIVES The Air Primary Angioplasty in Myocardial Infa rct ion ( PAMI ) study was design ed to determine the best reperfusion strategy for patients with high-risk acute myocardial infa rct ion ( AMI ) at hospitals without percutaneous transluminal coronary angioplasty ( PTCA ) capability . BACKGROUND Previous studies have suggested that high-risk patients have better outcomes with primary PTCA than with thrombolytic therapy . It is unknown whether this advantage would be lost if the patient had to be transferred for PTCA , and reperfusion was delayed . METHODS Patients with high-risk AMI ( age > 70 years , anterior MI , Killip class II/III , heart rate > 100 beats/min or systolic BP < 100 mm Hg ) who were eligible for thrombolytic therapy  were r and omized to either transfer for primary PTCA or on-site thrombolysis . RESULTS One hundred thirty-eight patients were r and omized before the study ended ( 71 to transfer for PTCA and 67 to thrombolysis ) . The time from arrival to treatment was delayed in the transfer group ( 155 vs. 51 min , p < 0.0001 ) , largely due to the initiation of transfer ( 43 min ) and transport time ( 26 min ) . Patients r and omized to transfer had a reduced hospital stay ( 6.1 + /- 4.3 vs. 7.5 + /- 4.3 days , p = 0.015 ) and less ischemia ( 12.7 % vs. 31.8 % , p = 0.007 ) . At 30 days , a 38 % reduction in major adverse cardiac events was observed for the transfer group ; however , because of the inability to recruit the necessary sample size , this did not achieve statistical significance ( 8.4 % vs. 13.6 % , p = 0.331 ) . CONCLUSIONS Patients with high-risk AMI at hospitals without a catheterization laboratory may have an improved outcome when transferred for primary PTCA versus on-site thrombolysis ; however , this will require further study . The marked delay in the transfer process suggests a role for triaging patients directly to specialized heart-attack centers OBJECTIVE To assess the safety and feasibility of acute transport followed by rescue percutaneous transluminal coronary angioplasty ( PTCA ) or primary PTCA in patients with acute myocardial infa rct ion initially admitted to a hospital without PTCA facilities . DESIGN In a multicentre r and omised open trial , three regimens of treatment of acute large myocardial infa rct ion were compared for patients admitted to hospitals without angioplasty facilities : thrombolytic treatment with alteplase ( 75 patients ) , alteplase followed by transfer to the PTCA centre and ( if indicated ) rescue PTCA ( 74 patients ) , or transfer for primary PTCA  ( 75 patients ) . RESULTS Between 1995 and 1997 224 patients were included . Baseline characteristics were distributed evenly . Transport to the PTCA centre was without severe complications in all patients . Mean ( SD ) delay from onset of symptoms to r and omisation was 130 ( 75 ) minutes and from r and omisation to angiography 90 ( 25 ) minutes . Death or recurrent infa rct ion within 42 days occurred in 12 patients in the thrombolysis group , in 10 patients in the rescue PTCA group , and in six patients in the primary PTCA group . These differences were not significant . CONCLUSIONS Acute transfer for rescue PTCA or primary PTCA in patients with extensive myocardial infa rct ion is feasible and safe . Efficacy of rescue PTCA or primary PTCA in this setting will have to be tested in larger series before this approach can be implemented as “ routine treatment ” for patients with extensive myocardial infa rct ion AIMS Our study aim ed to compare two reperfusion strategies in patients with ST-elevation myocardial infa rct ion ( S 
    Output:
    
Hence , compared with fibrinolysis , PPCI is expected to be the preferred method of revascularization in patients with AMI , especially in PCI-capable centers