| Routine invasive strategy within 24 hours of thrombolysis versus ischaemia-guided conservative approach for acute myocardial infarction with ST-segment elevation (GRACIA-1): a randomised controlled trial. | |
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MedLine Citation:
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PMID: 15380963 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: In patients with ST-segment elevated myocardial infarction (STEMI), early post-thrombolysis routine angioplasty has been discouraged because of its association with high incidence of events. The GRACIA-1 trial was designed to reassess the benefits of an early post-thrombolysis interventional approach in the era of stents and new antiplatelet agents. METHODS: 500 patients with thrombolysed STEMI (with recombinant tissue plasminogen activator) were randomly assigned to angiography and intervention if indicated within 24 h of thrombolysis, or to an ischaemia-guided conservative approach. The primary endpoint was the combined rate of death, reinfarction, or revascularisation at 12 months. Analysis was by intention to treat. FINDINGS: Invasive treatment included stenting of the culprit artery in 80% (199 of 248) patients, bypass surgery in six (2%), non-culprit artery stenting in three, and no intervention in 40 (16%). Predischarge revascularisation was needed in 51 of 252 patients in the conservative group. By comparison with patients receiving conservative treatment, by 1 year, patients in the invasive group had lower frequency of primary endpoint (23 [9%] vs 51 [21%], risk ratio 0.44 [95% CI 0.28-0.70], p=0.0008), and they tended to have reduced rate of death or reinfarction (7% vs 12%, 0.59 [0.33-1.05], p=0.07). Index time in hospital was shorter in the invasive group, with no differences in major bleeding or vascular complications. At 30 days both groups had a similar incidence of cardiac events. In-hospital incidence of revascularisation induced by spontaneous recurrence of ischaemia was higher in patients in the conservative group than in those in the invasive group. INTERPRETATION: In patients with STEMI, early post-thrombolysis catheterisation and appropriate intervention is safe and might be preferable to a conservative strategy since it reduces the need for unplanned in-hospital revascularisation, and improves 1-year clinical outcome. |
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Authors:
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Francisco Fernandez-Avilés; Joaquín J Alonso; Alfonso Castro-Beiras; Nicolás Vázquez; Jesús Blanco; Juan Alonso-Briales; Juan López-Mesa; Felipe Fernández-Vazquez; Isabel Calvo; Luis Martínez-Elbal; José A San Román; Benigo Ramos; |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Lancet Volume: 364 ISSN: 1474-547X ISO Abbreviation: Lancet Publication Date: 2004 Sep 18-24 |
Date Detail:
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Created Date: 2004-09-21 Completed Date: 2004-10-05 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 2985213R Medline TA: Lancet Country: England |
Other Details:
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Languages: eng Pagination: 1045-53 Citation Subset: AIM; IM |
Affiliation:
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Instituto de Ciencias del Corazón, Hospital Universitario, Valladolid, Spain. faviles@secardiologia.es |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Angioplasty, Transluminal, Percutaneous Coronary*
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adverse effects Combined Modality Therapy Coronary Angiography Coronary Artery Bypass Coronary Circulation Coronary Restenosis Electrocardiography Female Humans Male Middle Aged Myocardial Infarction / mortality, physiopathology, radiography, therapy* Stents* Stroke Volume Survival Rate Thrombolytic Therapy* / adverse effects |
| Comments/Corrections | |
Comment In:
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ACP J Club. 2005 Mar-Apr;142(2):38
[PMID:
15739985
]
Evid Based Cardiovasc Med. 2005 Mar;9(1):55-8 [PMID: 16379990 ] Lancet. 2005 Jan 29-Feb 4;365(9457):381; author reply 382 [PMID: 15680443 ] Lancet. 2004 Sep 18-24;364(9439):1014-5 [PMID: 15380948 ] Evid Based Cardiovasc Med. 2005 Mar;9(1):55-6, 59-60 [PMID: 16379991 ] |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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