Document Detail


Comparison of long-term prognostic evaluation between pre-intervention thrombolysis and primary coronary intervention: a prospective randomized trial: five-year results of the IMPORTANT study.
MedLine Citation:
PMID:  20571249     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Acute efficacy and long-term prognostic differences between ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (primary PCI) and those treated with pre-intervention thrombolysis combined with back-up of facilitated PCI has not been evaluated in Japanese patients. The purpose of the present study was therefore to evaluate the differences between treatment with primary PCI (primary-PCI group) and pre-treatment with tissue-type plasminogen activator (t-PA) combined with back-up of facilitated PCI (prior-t-PA group).
METHODS AND RESULTS: One hundred and one patients with STEMI were randomly assigned to 2 groups. Patients in the prior-t-PA group were then divided into 2 further groups, the facilitated-PCI and prior-t-PA alone groups. The patency rate at initial angiography, left ventricular ejection fraction (LVEF) at 6 months, and the major adverse cardiac event (MACE)-free rate at 5 years were then compared between the groups. The patency rate and LVEF in the prior-t-PA group was significantly higher than in the primary-PCI group (69% vs 17% respectively, P<0.001; 61.6+/-9.5% vs 55.0+/-11.6%, respectively; P=0.01). The MACE-free rate in the prior-t-PA group, however, was lower than in the primary-PCI group (58.7% vs 80.9%; P=0.03). The MACE-free rate in the facilitated-PCI group was equal to that in the primary-PCI group (73.7% vs 80.9%; P=0.39), whereas the MACE-free rate in the prior-t-PA-alone group was significantly lower than in the primary-PCI group (48.1% vs 80.9%; P=0.01).
CONCLUSIONS: Primary PCI is superior to pre-intervention thrombolysis for long-term prognosis. Moreover, facilitated PCI may be as effective as primary PCI in patients with STEMI.
Authors:
Tomonori Itoh; Ken'ichi Fukami; Tomomi Suzuki; Takumi Kimura; Yoshinori Kanaya; Makoto Orii; Iwao Goto; Hiroki Matsui; Shoma Sugawara; Satoshi Nakajima; Tetsuya Fusazaki; Motoyuki Nakamura;
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't     Date:  2010-06-19
Journal Detail:
Title:  Circulation journal : official journal of the Japanese Circulation Society     Volume:  74     ISSN:  1347-4820     ISO Abbreviation:  Circ. J.     Publication Date:  2010 Aug 
Date Detail:
Created Date:  2010-07-30     Completed Date:  2010-12-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101137683     Medline TA:  Circ J     Country:  Japan    
Other Details:
Languages:  eng     Pagination:  1625-34     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Department of Internal Medicine, Memorial Heart Center, Iwate Medical University, Morioka 020-8505, Japan. t_itoh@imu.ncvc.go.jp
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary / methods*
Coronary Angiography
Disease-Free Survival
Humans
Middle Aged
Prognosis
Stroke Volume
Thrombolytic Therapy / methods*
Time Factors
Tissue Plasminogen Activator / administration & dosage*
Treatment Outcome
Chemical
Reg. No./Substance:
EC 3.4.21.68/Tissue Plasminogen Activator
Investigator
Investigator/Affiliation:
S Oriso / ; I Motegi / ; K Tamaki / ; K Ohoshima / ; N Hoshi / ; T Shiroto / ; M Ohosawa / ; M Kawakami / ; N Moriai / ; T Ichikawa / ; S Saiki / ; H Aoki / ; F Satoh / ; H Mukaida / ; H Endoh / ; K Nasu / ; T Yago / ; H Ishida / ; O Nishiyama / ; T Okajima / ; S Mifune / ; J Nakano / ; A Okayama / ; K Hiramori /
Comments/Corrections
Comment In:
Circ J. 2010 Aug;74(8):1530-1   [PMID:  20647629 ]
Erratum In:
Circ J. 2010 Sep;74(9):2027

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