| Benefit of facilitated percutaneous coronary intervention in high-risk ST-segment elevation myocardial infarction patients presenting to nonpercutaneous coronary intervention hospitals. | |
| | |
MedLine Citation:
|
PMID: 19850249 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
OBJECTIVES: We hypothesized that patients most likely to benefit would be those at high risk with a shorter duration of acute ischemia and who required transfer for percutaneous coronary intervention (PCI). BACKGROUND: The FINESSE (Facilitated Intervention with Enhanced Reperfusion Speed to Stop Events) study failed to demonstrate an improvement in the 90-day composite clinical end point of early treatment with abciximab plus half-dose reteplase (combination-facilitated PCI) or abciximab alone. METHODS: We performed a retrospective analysis of 2,452 patients in this double-blind, placebo-controlled study. Patients were stratified by Thrombolysis In Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI), presentation to a spoke (no PCI available) or hub site, and symptom-to-randomization time. Outcomes included the primary composite end point of death, ventricular fibrillation after 48 h, cardiogenic shock, and congestive heart failure through day 90 as well as 1-year mortality. RESULTS: Mortality for all patients at 1 year was directly related to TIMI risk score (23 of 1,223 = 1.9% in patients with score <3 and 145 of 1,229 = 11.8% with score > or =3, p < 0.001). Patients with TIMI risk score > or =3 and presentation to a spoke site with a symptom-to-randomization time < or =4 h had significantly better 1-year survival if treated with combination-facilitated PCI (hazard ratio [HR]: 0.351, p = 0.01) as well as 90-day composite outcome (HR: 0.45, p = 0.009). A trend for improved survival was also observed in patients with TIMI score > or =3 and spoke site alone (HR: 0.549, p = 0.06). CONCLUSIONS: Facilitation of PCI with a combination of abciximab and half-dose reteplase improved survival at 1 year in high-risk patients presenting to a spoke hospital with symptom-to-randomization time < or =4 h. Further prospective study of facilitated PCI in this subgroup of patients is warranted. |
| | |
Authors:
|
Howard C Herrmann; Jiandong Lu; Bruce R Brodie; Paul W Armstrong; Gilles Montalescot; Amadeo Betriu; Franz-Joseph Neuman; Mark B Effron; Elliot S Barnathan; Eric J Topol; Stephen G Ellis; |
Related Documents
:
|
21110199 - Comparison of the effects of nitroprusside versus nicorandil on the slow/no-reflow phen... 22974299 - Uncovering the molecular and cellular mechanisms of heart development using the zebrafish. 23592769 - Coronary microemboli effects in preexisting acute infarcts in a swine model: cardiac mr... 17497429 - Clopidogrel resistance--the cardiologist's perspective. 16516579 - Association between level of platelet inhibition after early use of abciximab and myoca... 23301719 - The spectrum of acute heart failure after venlafaxine overdose. 19491569 - Clopidogrel in the management of acute coronary syndromes: indications, results, obstac... 10490559 - Serum total homocysteine and coronary heart disease: prospective study in middle aged men. 725619 - Role of the psyche in recovery from myocardial infarction. |
Publication Detail:
|
Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
|
Title: JACC. Cardiovascular interventions Volume: 2 ISSN: 1876-7605 ISO Abbreviation: JACC Cardiovasc Interv Publication Date: 2009 Oct |
Date Detail:
|
Created Date: 2009-10-23 Completed Date: 2010-01-07 Revised Date: 2013-05-24 |
Medline Journal Info:
|
Nlm Unique ID: 101467004 Medline TA: JACC Cardiovasc Interv Country: United States |
Other Details:
|
Languages: eng Pagination: 917-24 Citation Subset: IM |
Affiliation:
|
Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA. howard.herrmann@uphs.upenn.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
|
ClinicalTrials.gov/NCT00046228 |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Angioplasty, Balloon, Coronary*
/
adverse effects,
mortality Antibodies, Monoclonal / adverse effects, therapeutic use* Combined Modality Therapy Double-Blind Method Fibrinolytic Agents / adverse effects, therapeutic use* Health Services Accessibility* Hemorrhage / chemically induced Humans Immunoglobulin Fab Fragments / adverse effects, therapeutic use* Kaplan-Meier Estimate Multicenter Studies as Topic Myocardial Infarction / mortality, therapy* Patient Transfer Platelet Aggregation Inhibitors / adverse effects, therapeutic use* Randomized Controlled Trials as Topic Recombinant Proteins / adverse effects, therapeutic use Retrospective Studies Risk Assessment Risk Factors Thrombolytic Therapy* / adverse effects, mortality Time Factors Tissue Plasminogen Activator / adverse effects, therapeutic use* Treatment Outcome |
| Chemical | |
Reg. No./Substance:
|
0/Antibodies, Monoclonal; 0/Fibrinolytic Agents; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; 0/Recombinant Proteins; 133652-38-7/reteplase; EC 3.4.21.68/Tissue Plasminogen Activator; X85G7936GV/abciximab |
| Comments/Corrections | |
Comment In:
|
JACC Cardiovasc Interv. 2009 Oct;2(10):931-3
[PMID:
19850251
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: 1-year survival in a randomized trial of facilitated reperfusion: results from the FINESSE (Facilita...
Next Document: The impact of place of enrollment and delay to reperfusion on 90-day post-infarction mortality in th...