We appreciate the comments by Rosell-Ortiz et al. Indeed, half the patients in our study required transfer between centers for primary angioplasty with the associated delay that this entails.1 Although some randomized studies have shown noninferiority of fibrinolysis therapy in the first few hours after ST-elevation myocardial infarction compared with primary angioplasty,2 in general, primary angioplasty is superior, given its greater reperfusion efficacy and lower frequency of complications and bleeding complications in particular.3 Another recent analysis of patients treated according to the Codi Infart protocol within 2hours of infarction also reported that primary angioplasty was superior to fibrinolysis, except when the delay from first medical contact to reperfusion exceeded 140minutes.4
The Codi Infart protocol includes administration of fibrinolysis when the delay between first medical contact and reperfusion is expected to be longer than 120minutes on the basis of availability of a catheterization laboratory, number of ambulances, and traffic in the area. This strategy is also used in other consolidated care systems such as that in Asturias, with a different orography to that in Catolonia, although also with excellent results.5 The geography of Catalonia is not complex, which usually allows primary angioplasty within the recommended timeframe. Fibrinolysis (and subsequent transfer to a referral hospital with a catheterization laboratory) is reserved for situations when the timeframe is truly unrealistic (that is, centers a very long way from the referral hospital). This suggests that most delays could be shortened by much earlier diagnosis and drainage after first contact.
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We thank all the health care professionals involved in the Codi Infart program.