| Predictors of infarct artery patency after prehospital thrombolysis: the multicentre, prospective, observational OPTIMAL study. | |
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MedLine Citation:
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PMID: 19074922 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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. |
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Authors:
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V Bongard; J Puel; D Savary; L Belle; S Charpentier; Y Cottin; L Soulat; M Elbaz; D Miljkovic; Ph G Steg; |
Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't Date: 2008-12-15 |
Journal Detail:
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Title: Heart (British Cardiac Society) Volume: 95 ISSN: 1468-201X ISO Abbreviation: Heart Publication Date: 2009 May |
Date Detail:
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Created Date: 2009-04-29 Completed Date: 2009-06-19 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9602087 Medline TA: Heart Country: England |
Other Details:
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Languages: eng Pagination: 799-806 Citation Subset: AIM; IM |
Affiliation:
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Department of Epidemiology, Centre Hospitalier Universitaire de Toulouse, Université de Toulouse, Toulouse, France. bongard@cict.fr |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Coronary Angiography / methods* Emergency Medical Services* Epidemiologic Methods Female Humans Male Middle Aged Myocardial Infarction / drug therapy*, physiopathology, radiography Practice Guidelines as Topic Thrombolytic Therapy / methods* Treatment Outcome Vascular Patency / physiology* |
| Investigator | |
Investigator/Affiliation:
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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 / |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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