Document Detail

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    
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.
Ronen Jaffe; David A Halon; Basheer Karkabi; Jacob Goldstein; Ronen Rubinshtein; Moshe Y Flugelman; Basil S Lewis
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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
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.
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MeSH Terms
Aged, 80 and over
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Artery Bypass
Fibrinolytic Agents / therapeutic use*
Middle Aged
Myocardial Infarction / drug therapy*,  mortality,  therapy
Streptokinase / therapeutic use
Thrombolytic Therapy* / mortality
Tissue Plasminogen Activator / therapeutic use
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.-/Streptokinase; EC Plasminogen Activator
Comment In:
Cardiology. 2007;107(4):337-9   [PMID:  17268199 ]

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