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Left ventricular function in acute myocardial infarction treated with thrombolysis followed by early versus late invasive strategy.
MedLine Citation:
PMID:  20598975     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Thrombolysis remains the treatment of choice in acute ST-segment elevation myocardial infarction (STEMI) when primary percutaneous coronary intervention (PCI) cannot be performed within 90 to 120 minutes. The optimal treatment after thrombolysis is still debated, but several studies have shown improved clinical outcomes with early transfer for PCI. The aim of this study was to investigate whether an early invasive strategy after thrombolysis preserved left ventricular function better than a late invasive strategy. METHODS: This was a substudy of the NORwegian study on DIstrict treatment of ST-Elevation Myocardial Infarction. Patients with STEMI of <6 hours of duration and >90 minutes of expected transfer delays to PCI were treated with aspirin, tenecteplase, enoxaparin, and clopidogrel and randomized to early or late invasive strategy (N = 266). Left ventricular volumes and ejection fraction were assessed by single-photon emission computed tomography, echocardiography, and magnetic resonance imaging 3 months after the index infarction. RESULTS: Noninvasive imaging was completed in 241 patients (91%). Median end-diastolic and end-systolic volumes after 3 months did not differ between groups. Median ejection fraction was well preserved and also without differences: 63% (interquartile range 51-70) in the early invasive versus 65% (interquartile range 55-71) in the late invasive group when assessed by single-photon emission computed tomography (P = .30), 55% versus 55% when assessed by echocardiography (P = .88), and 57% versus 57% when assessed by magnetic resonance imaging (P = .99). CONCLUSION: In this group of STEMI patients treated with thrombolysis, no difference in left ventricular function after 3 months was found between patients treated with early versus late invasive strategy.
Nisha Mistry; Ellen Bøhmer; Pavel Hoffmann; Carl Müller; Reidar Bjørnerheim; Sverre E Kjeldsen; Sigrun Halvorsen
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  American heart journal     Volume:  160     ISSN:  1097-6744     ISO Abbreviation:  Am. Heart J.     Publication Date:  2010 Jul 
Date Detail:
Created Date:  2010-07-05     Completed Date:  2010-08-17     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0370465     Medline TA:  Am Heart J     Country:  United States    
Other Details:
Languages:  eng     Pagination:  73-9     Citation Subset:  AIM; IM    
Copyright Information:
Copyright (c) 2010 Mosby, Inc. All rights reserved.
Department of Cardiology, Oslo University Hospital Ullevaal, Oslo, Norway.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Coronary Angiography
Drug Therapy, Combination
Fibrinolytic Agents / therapeutic use*
Follow-Up Studies
Magnetic Resonance Imaging
Middle Aged
Myocardial Infarction / diagnosis,  physiopathology*,  therapy
Platelet Aggregation Inhibitors / therapeutic use*
Thrombolytic Therapy / methods*
Tomography, Emission-Computed, Single-Photon
Treatment Outcome
Ventricular Function, Left / physiology*
Reg. No./Substance:
0/Fibrinolytic Agents; 0/Platelet Aggregation Inhibitors

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