Document Detail

Predictors of infarct artery patency after prehospital thrombolysis: the multicentre, prospective, observational OPTIMAL study.
MedLine Citation:
PMID:  19074922     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To identify predictors of early TIMI 3 flow patency of the infarct-related artery after prehospital thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI) using data from a "real-world" population, and to develop a nomogram for triaging patients to emergency angiography. DESIGN: Multicentre, observational, prospective, cohort study. SETTING: 79 Hospitals in France with a prehospital mobile intensive care unit and a coronary care unit with 24 h access to coronary angiography. PATIENTS: 997 Patients with STEMI. INTERVENTIONS: All patients received prehospital thrombolysis within 6 h of symptom onset and angiography was performed within 6 h of thrombolysis. MAIN OUTCOME MEASURES: Coronary patency (TIMI flow). RESULTS: The median age of the population was 59 years and the sample comprised 18% women. After multivariable logistic regression analysis, predictors of TIMI 3 flow in the infarct-related artery were current/previous smoking (odds ratio (OR) = 1.60, 95% confidence interval 1.15 to 2.22), < or =5 leads with ST-segment elevation before thrombolysis (OR = 1.59, 1.12 to 2.25), Killip class I (OR = 1.96, 1.05 to 3.67), chest pain relief (OR = 1.62, 1.17 to 2.25) and ST-segment resolution > or =70% (OR = 1.76, 1.29 to 2.38). A nomogram was developed to assess the probability of TIMI 3 flow, according to smoking status, number of leads with ST elevation before thrombolysis, Killip class, chest pain relief and ST-segment resolution. CONCLUSIONS: This study provides quantitative data for predicting success of prehospital thrombolysis. The nomogram is a simple tool for predicting likelihood of coronary patency, based on clinical and electrocardiographic data. It may help to identify patients who require emergency angiography and rescue percutaneous coronary intervention.
V Bongard; J Puel; D Savary; L Belle; S Charpentier; Y Cottin; L Soulat; M Elbaz; D Miljkovic; Ph G Steg;
Publication Detail:
Type:  Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't     Date:  2008-12-15
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  95     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-04-29     Completed Date:  2009-06-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  England    
Other Details:
Languages:  eng     Pagination:  799-806     Citation Subset:  AIM; IM    
Department of Epidemiology, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France.
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MeSH Terms
Coronary Angiography / methods*
Emergency Medical Services*
Epidemiologic Methods
Middle Aged
Myocardial Infarction / drug therapy*,  physiopathology,  radiography
Practice Guidelines as Topic
Thrombolytic Therapy / methods*
Treatment Outcome
Vascular Patency / physiology*
F Berthier / ; J L Bordonado / ; S Charpentier / ; P Goldstein / ; Y Lambert / ; F Lapostolle / ; A Ricard-Hibon / ; D Savary / ; J L Sebbah / ; L Soulat / ; K Tazarourte / ; L Belle / ; P Coste / ; Y Cottin / ; N Danchin / ; K Khalifé / ; C Loubeyre / ; J Puel / ; F Schiele / ; P G Steg / ; P Virot /

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