| Thrombolysis followed by early revascularization: an effective reperfusion strategy in real world patients with ST-elevation myocardial infarction. | |
| | |
MedLine Citation:
|
PMID: 17268198 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
BACKGROUND: Several trials suggested superiority of primary percutaneous coronary intervention (PPCI) angioplasty over thrombolysis in patients with ST-elevation myocardial infarction (STEMI), but many trials were characterized by low rates of early revascularization in patients treated with initial thrombolysis. We tested the hypothesis that in patients with hemodynamically stable STEMI, initial thrombolysis followed by an active early rescue/definitive revascularization strategy could achieve salutary short- and long-term outcomes. METHODS: A prospective registry documented all 212 STEMI patients who received initial thrombolytic therapy over a 2-year period in a single medical center. Median patient age was 58 (range: 29-92) years, 47 (22%) patients were aged >70 years and 18 (8%) >80 years. Fifty-two (25%) patients underwent rescue angioplasty <6 h after thrombolysis for inadequate clinical reperfusion. In 194/212 (92%) patients, coronary angiography was performed during initial hospitalization, PCI in 168 (79%), and coronary bypass surgery in 18 (8%). RESULTS: Thirty-day mortality was 4.7% and 1-year mortality 6.7%. Mortality was not related to diabetes mellitus, hypertension, anterior infarction location, fibrin-specific thrombolytic drug or rescue PCI. By multivariate analysis, in-hospital definitive angiography/revascularization (p < 0.0001) and TIMI risk score >3 on admission (p < 0.01) were significant independent predictors of both 30 day and 12 month outcome. CONCLUSIONS: Initial thrombolysis was useful and effective in real-world STEMI patients when coupled with an aggressive policy of rescue angioplasty and early in-hospital revascularization. Outcomes compared favorably with those reported for PPCI trials. The adverse prognosis in older patients with higher TIMI risk score suggests that in those patients alternative initial treatment strategies such as PPCI should be considered. |
| | |
Authors:
|
Ronen Jaffe; David A Halon; Basheer Karkabi; Jacob Goldstein; Ronen Rubinshtein; Moshe Y Flugelman; Basil S Lewis |
Related Documents
:
|
20938098 - Three-month dual antiplatelet therapy after implantation of zotarolimus-eluting stents:... 14699708 - Treatment modalities of non-st-elevation acute coronary syndromes in the real world. re... 15546298 - Influence of doxycycline on clinical and angiographic outcome following percutaneous co... 20398868 - The clinical impact of routine angiographic follow-up in randomized trials of drug-elut... 23053778 - Scleral fixation of standard capsular tension ring and in-the-bag intraocular lens impl... 3379288 - Thumb metacarpophalangeal capsulodesis: an adjunct procedure to basal joint arthroplast... |
Publication Detail:
|
Type: Journal Article Date: 2007-01-24 |
Journal Detail:
|
Title: Cardiology Volume: 107 ISSN: 1421-9751 ISO Abbreviation: Cardiology Publication Date: 2007 |
Date Detail:
|
Created Date: 2007-05-16 Completed Date: 2007-06-26 Revised Date: - |
Medline Journal Info:
|
Nlm Unique ID: 1266406 Medline TA: Cardiology Country: Switzerland |
Other Details:
|
Languages: eng Pagination: 329-36 Citation Subset: IM |
Copyright Information:
|
2007 S. Karger AG, Basel |
Affiliation:
|
Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center and the Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Adult Aged Aged, 80 and over Angioplasty, Transluminal, Percutaneous Coronary Coronary Artery Bypass Female Fibrinolytic Agents / therapeutic use* Humans Male Middle Aged Myocardial Infarction / drug therapy*, mortality, therapy Streptokinase / therapeutic use Thrombolytic Therapy* / mortality Tissue Plasminogen Activator / therapeutic use |
| Chemical | |
Reg. No./Substance:
|
0/Fibrinolytic Agents; EC 3.4.-/Streptokinase; EC 3.4.21.68/Tissue Plasminogen Activator |
| Comments/Corrections | |
Comment In:
|
Cardiology. 2007;107(4):337-9
[PMID:
17268199
]
|
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: ATP-binding cassette transporter A1 gene I823M polymorphism affects plasma high-density lipoprotein ...
Next Document: Tumor necrosis factor-alpha-308 gene polymorphism in Croatian and Slovenian multiple sclerosis patie...