Document Detail


Facilitated primary coronary intervention with abciximab and very low dose of alteplase during off-hours compared with direct primary intervention during regular hours.
MedLine Citation:
PMID:  15973688     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In patients with acute myocardial infarction (AMI), the off-hour presentation is one of the major determinants of door-to-balloon delay. Moreover, the nighttime presentation is associated with increased mortality after primary coronary intervention (PCI). The prompt starting of a therapy able to start recanalization of the infarct-related artery before intervention might improve the results of off-hour primary PCI. We compared the outcome of 212 consecutive patients with AMI undergoing either direct or facilitated PCI according to the hour of presentation. Patients arriving off-hours were pretreated with alteplase (20 mg) and abciximab and underwent facilitated PCI. Patients presenting on-hours underwent direct PCI. A basal Thrombolysis in Myocardial Infarction (TIMI) flow grade 3 was observed in 1.0% of patients undergoing direct PCI and in 44% of patients undergoing facilitated PCI (P = 0.001). More patients starting PCI with a TIMI 3 flow achieved a postinterventional fast TIMI frame count (72.0% vs. 38.8% direct PCI group vs. 34.9% facilitated PCI group with basal TIMI 0-2; P = 0.001) and a TIMI perfusion grade 3 (66.0% vs. 38.8% direct PCI group vs. 39.7% facilitated PCI group with basal TIMI 0-2; P = 0.004). Preinterventional TIMI flow grade 3 was associated with a higher gain in left ventricular ejection fraction at 1 month (10.9% +/- 6.4% vs. 7.0% +/- 9.6% direct PCI group vs. 6.1% +/- 6.0% facilitated PCI group with basal TIMI 0-2; P = 0.005). No significant difference was observed in major bleedings, although there was a trend toward a higher risk in the facilitated PCI group. Patients in the facilitated PCI group achieving a basal TIMI 3 flow showed improved myocardial reperfusion and better left ventricular function recovery. Bleeding complications associated with combination therapy remained an important concern.
Authors:
Mauro Maioli; Michela Gallopin; Mario Leoncini; Francesco Bellandi; Anna Toso; Roberto Piero Dabizzi
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions     Volume:  65     ISSN:  1522-1946     ISO Abbreviation:  Catheter Cardiovasc Interv     Publication Date:  2005 Aug 
Date Detail:
Created Date:  2005-07-27     Completed Date:  2005-12-21     Revised Date:  2013-05-24    
Medline Journal Info:
Nlm Unique ID:  100884139     Medline TA:  Catheter Cardiovasc Interv     Country:  United States    
Other Details:
Languages:  eng     Pagination:  484-91     Citation Subset:  IM    
Affiliation:
Division of Cardiology, Misericordia e Dolce Hospital, Prato, Italy. mauromaioli@tiscali.it
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary*
Antibodies, Monoclonal / therapeutic use*
Coronary Angiography
Coronary Circulation / physiology
Drug Therapy, Combination
Female
Fibrinolytic Agents / administration & dosage*
Follow-Up Studies
Hospital Mortality
Humans
Immunoglobulin Fab Fragments / therapeutic use*
Italy
Male
Middle Aged
Myocardial Infarction / physiopathology,  radiography,  therapy*
Platelet Aggregation Inhibitors / therapeutic use*
Postoperative Complications / etiology,  mortality,  physiopathology
Stroke Volume / physiology
Time Factors
Tissue Plasminogen Activator / administration & dosage*
Treatment Outcome
Ventricular Function, Left / physiology
Chemical
Reg. No./Substance:
0/Antibodies, Monoclonal; 0/Fibrinolytic Agents; 0/Immunoglobulin Fab Fragments; 0/Platelet Aggregation Inhibitors; EC 3.4.21.68/Tissue Plasminogen Activator; X85G7936GV/abciximab

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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