Document Detail


Long-term clinical outcomes after rescue angioplasty are not different from those of successful thrombolysis for acute myocardial infarction.
MedLine Citation:
PMID:  15930039     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIMS: The long-term value of rescue percutaneous transluminal coronary angioplasty (PTCA) in patients with ST-segment elevation myocardial infarction who received thrombolytic therapy but failed to achieve early recanalization of the artery is still debated. This study aimed to compare long-term outcomes after successful thrombolysis vs. systematic attempted rescue PTCA. METHODS AND RESULTS: A total of 362 consecutive patients with STEMI hospitalized within 6 h of symptom onset and treated with intravenous thrombolytic therapy were studied. Of these, 345 underwent coronary angiography within 90 min. Sixty per cent of patients achieved TIMI 3 flow and were treated medically; the in-hospital death rate in this group was 4%. Nine per cent of patients had TIMI 2 flow and 31% TIMI 0-1 flow. In this latter group, rescue PTCA was attempted in 85.8% with a hospital death rate of 5.5% (20% with failed vs. 4% with successful rescue PTCA, P=0.03). Eight year actuarial survival without recurrent myocardial infarction was no different in patients who had successful thrombolytic therapy and in patients with attempted rescue PTCA [78 and 95% CI (71-85) vs. 78 and 95% CI (68-87), respectively, hazard ratio: 0.93 (0.52-1.65), P=0.80]. Total mortality, cardiac mortality, and other composite endpoints also did not differ between groups. CONCLUSION: Routine attempted rescue PTCA 90 min after thrombolytic therapy in patients with persistent occlusion of the infarct-related vessels achieves long-term clinical outcomes which do not differ from those obtained by successful thrombolysis.
Authors:
Philippe Gabriel Steg; Laurent Francois; Bernard Iung; Dominique Himbert; Pierre Aubry; Patrick Charlier; Hakim Benamer; Laurent J Feldman; Jean-Michel Juliard
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Publication Detail:
Type:  Comparative Study; Journal Article; Randomized Controlled Trial     Date:  2005-06-01
Journal Detail:
Title:  European heart journal     Volume:  26     ISSN:  0195-668X     ISO Abbreviation:  Eur. Heart J.     Publication Date:  2005 Sep 
Date Detail:
Created Date:  2005-08-29     Completed Date:  2006-02-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8006263     Medline TA:  Eur Heart J     Country:  England    
Other Details:
Languages:  eng     Pagination:  1831-7     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Hôpital Bichat-Claude Bernard, Assistance Publique-Hôpitaux de Paris, 46 rue Henri Huchard, 75877 Paris Cedex 18, France. gabriel.steg@bch.ap-hop-paris.fr
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Transluminal, Percutaneous Coronary / methods*,  mortality
Emergency Treatment / methods
Female
Hospital Mortality
Humans
Male
Middle Aged
Myocardial Infarction / mortality,  therapy*
Recurrence
Stents
Survival Analysis
Thrombolytic Therapy / methods*,  mortality
Treatment Outcome
Comments/Corrections
Comment In:
Eur Heart J. 2005 Sep;26(18):1813-5   [PMID:  15958433 ]

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