Document Detail


Thorombolytic therapy with rescue percutaneous coronary intervention versus primary percutaneous coronary intervention in patients with acute myocardial infarction: a multicenter randomized clinical trial.
MedLine Citation:
PMID:  20819587     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Although thrombolytic therapy with rescue percutaneous coronary intervention (PCI) is a common treatment strategy for ST-segment elevation acute myocardial infarction (STEMI), scant data are available on its efficacy relative to primary PCI, and comparison was therefore the aim of this study.
METHODS: This multicenter, open-label, randomized, parallel trial was conducted in 12 hospitals on patients (age < or = 70 years) with STEMI who presented within 12 hours of symptom onset (mean interval > 3 hours). Patients were randomized to three groups: primary PCI group (n = 101); recombinant staphylokinase (r-Sak) group (n = 104); and recombinant tissue-type plasminogen activator (rt-PA) group (n = 106). For all patients allocated to the thrombolytic therapy arm, coronary angiography was performed at 90 minutes after drug therapy to confirm infarct-related artery (IRA) patency; rescue PCI was performed in cases with TIMI flow grade < or = 2. Bare-metal stent implantation was planned for all patients.
RESULTS: After randomization it required an average of 113.4 minutes to start thrombolytic therapy (door-to-needle time) and 141.2 minutes to perform first balloon inflation in the IRA (door to balloon time). Rates of IRA patency (TIMI flow grade 2 or 3) and TIMI flow grade 3 were significantly lower in the thrombolysis group at 90 minutes after drug therapy than in the primary PCI group at the end of the procedure (70.5% vs. 98.0%, P < 0.0001, and 53.0% vs. 85.9%, P < 0.0001, respectively). Rescue PCI with stenting was performed in 117 patients (55.7%) in the thrombolytic therapy arm. Rates of patency and TIMI flow grade 3 were still significantly lower in the rescue PCI than in the primary PCI group (88.9% vs. 97.9%, P = 0.0222, and 68.4% vs. 85.0%, P = 0.0190, respectively). At 30 days post-therapy, mortality rate was significantly higher in the thrombolysis combined with rescue PCI group than in primary PCI group (7.1% vs. 0, P = 0.0034). Rates of death/MI and bleeding complications were significantly higher in the thrombolysis with rescue PCI group than in the primary PCI group (10.0% vs. 1.0%, P = 0.0380, and 28.10% vs. 8.91%, P = 0.0001, respectively).
CONCLUSIONS: Thrombolytic therapy with rescue PCI was associated with significantly lower rates of coronary patency and TIMI flow grade 3, but with significantly higher rates of mortality, death/MI and hemorrhagic complications at 30 days, as compared with primary PCI in this group of Chinese STEMI patients with late presentation and delayed treatments.
Authors:
Run-lin Gao; Ya-ling Han; Xin-chun Yang; Jie-ming Mao; Wei-yi Fang; Lei Wang; Wei-feng Shen; Zhan-quan Li; Guo-liang Jia; Shu-zheng Lü; Meng Wei; Ding-yin Zeng; Ji-lin Chen; Xue-wen Qin; Bo Xu; Chang-hui DU;
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Publication Detail:
Type:  Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  Chinese medical journal     Volume:  123     ISSN:  0366-6999     ISO Abbreviation:  Chin. Med. J.     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-09-07     Completed Date:  2010-12-22     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7513795     Medline TA:  Chin Med J (Engl)     Country:  China    
Other Details:
Languages:  eng     Pagination:  1365-72     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Cardiovascular Institute & Fu Wai Hospital, Chinese Academy of Medical Sciences, Beijing 100037, China. gaorunlin@263.net
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MeSH Terms
Descriptor/Qualifier:
Aged
Angioplasty, Balloon, Coronary*
Coronary Angiography
Female
Fibrinolytic Agents / therapeutic use
Humans
Male
Middle Aged
Myocardial Infarction / drug therapy,  therapy*
Thrombolytic Therapy*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents
Investigator
Investigator/Affiliation:
Qi Fang / ; Zai-jia Chen / ; Run-lin Gao / ; Ji-lin Chen / ; Run-lin Gao / ; Ji-lin Chen / ; Wei-feng Shen / ; Jie-ming Mao / ; Xin-chun Yang / ; Zong-zan Ni / ; Qi Fang / ; Zai-jia Chen / ; Run-lin Gao / ; Ji-lin Chen / ; Run-lin Gao / ; Ji-lin Chen / ; Wei-feng Shen / ; Jie-ming Mao / ; Xin-chun Yang / ; Zong-zan Ni / ; Chang-hui Du / ; Bo Xu / ; Chong-jian Li / ; Ya-ling Han / ; Xin-chun Yang / ; Run-lin Gao / ; Wei-yi Fang / ; Lei Wang / ; Wei-feng Shen / ; Zhan-quan Li / ; Guo-liang Jia / ; Shu-zheng Lü / ; Meng Wei / ; Ding-yi Deng / ; Xue-wen Qin / ; Yue-jin Yang / ; Shu-bin Qiao / ; Min Yao / ; Hai-bo Liu / ; Yong-jian Wu / ; Jin-qing Yuan / ; Jue Chen / ; Yuan Wu / ; Kun Huang / ; Jin-fa Shi /
Comments/Corrections
Comment In:
Chin Med J (Engl). 2010 Jun;123(11):1363-4   [PMID:  20819586 ]

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