| Simple risk stratification at admission to identify patients with reduced mortality from primary angioplasty. | |
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MedLine Citation:
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PMID: 16186438 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Randomized trials comparing fibrinolysis with primary angioplasty for acute ST-elevation myocardial infarction have demonstrated a beneficial effect of primary angioplasty on the combined end point of death, reinfarction, and disabling stroke but not on all-cause death. Identifying a patient group with reduced mortality from an invasive strategy would be important for early triage. The Thrombolysis in Myocardial Infarction (TIMI) risk score is a simple validated integer score that makes it possible to identify high-risk patients on admission to hospital. We hypothesized that a high-risk group might have a reduced mortality with an invasive strategy. METHODS AND RESULTS: We classified 1527 patients from the Danish Multicenter Randomized Study on Fibrinolytic Therapy Versus Acute Coronary Angioplasty in Acute Myocardial Infarction (DANAMI-2) trial with information for all variables necessary for calculating the TIMI risk score as low risk (TIMI risk score, 0 to 4) or high risk (TIMI risk score > or =5) and investigated the effect of primary angioplasty versus fibrinolysis on mortality and morbidity in the 2 groups. Follow-up was 3 years. We classified 1134 patients as low risk and 393 as high risk. There was a significant interaction between risk status and effect of primary angioplasty (P=0.008). In the low-risk group, there was no difference in mortality (primary angioplasty, 8.0%; fibrinolysis, 5.6%; P=0.11); in the high-risk group, there was a significant reduction in mortality with primary angioplasty (25.3% versus 36.2%; P=0.02). CONCLUSIONS: Risk stratification at admission based on the TIMI risk score identifies a group of high-risk patients who have a significantly reduced mortality with an invasive strategy of primary angioplasty. |
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Authors:
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Jens Jakob Thune; Dan Eik Hoefsten; Matias Greve Lindholm; Leif Spange Mortensen; Henning Rud Andersen; Torsten Toftegaard Nielsen; Lars Kober; Henning Kelbaek; |
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Publication Detail:
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Type: Journal Article |
Journal Detail:
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Title: Circulation Volume: 112 ISSN: 1524-4539 ISO Abbreviation: Circulation Publication Date: 2005 Sep |
Date Detail:
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Created Date: 2005-09-27 Completed Date: 2006-02-14 Revised Date: 2007-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: United States |
Other Details:
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Languages: eng Pagination: 2017-21 Citation Subset: AIM; IM |
Affiliation:
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Department of Cardiology, University Hospital of Copenhagen, Rigshospitalet, DK-2100 Copenhagen, Denmark. jjt@heart.dk |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Angioplasty, Transluminal, Percutaneous Coronary / mortality* Female Follow-Up Studies Humans Male Middle Aged Multicenter Studies as Topic Myocardial Infarction / drug therapy Patient Admission* Patients* Randomized Controlled Trials as Topic Risk Assessment* / methods Thrombolytic Therapy / adverse effects, mortality |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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