Document Detail


The Zwolle global experience on primary percutaneous coronary intervention.
MedLine Citation:
PMID:  16008149     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Timely restoration of antegrade blood flow in the infarct-related artery of patients with ST-segment elevation myocardial infarction (STEMI) results in myocardial salvage and improved survival. We describe the Zwolle approach with regard to prehospital phase, the first 15 min in hospital, initial pharmacological therapy, angiography, angioplasty, risk stratification, rehabilitation and secondary prevention. Confirmation of the diagnosis by 12-lead electrocardiography by either general practitioners or ambulance paramedics allows substantial reduction in the time-delay to first balloon inflation, as the hospital and the catheterization laboratory can be prepared in advance, and the emergency room and the coronary care unit with their unavoidable delays can be skipped on the way to acute angiography. In our setting all patients with STEMI are treated at the time of diagnosis (before or during transportation) with heparin (5000 IU) and aspirin (500 mg) intravenously, with additional oral bolus (300 mg) of clopidogrel and additional 5000 IU heparin at the time of angiography. Our attitude is that an optimal balloon angioplasty result should never be jeopardized just for somewhat lower rate of target vessel revascularization during the first year after the acute event. In particular, attention should be paid to side branches, which may be of more clinical relevance in this setting than with elective angioplasty. Additional mechanical devices, such as distal protection devices and/or thrombosuction, should be mostly used when relevant thrombotic material is visible, with concomitant higher risk of distal embolization, particularly in high-risk patients. Finally, the use of the Zwolle risk score may help to identify low-risk patients who could be safely discharged within 36-48 hours after primary angioplasty, with a significant reduction in the costs of hospitalization.
Authors:
Giuseppe De Luca; Harry Suryapranata; Menko-Jan de Boer
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Publication Detail:
Type:  Journal Article; Review    
Journal Detail:
Title:  Italian heart journal : official journal of the Italian Federation of Cardiology     Volume:  6     ISSN:  1129-471X     ISO Abbreviation:  Ital Heart J     Publication Date:  2005 Jun 
Date Detail:
Created Date:  2005-07-12     Completed Date:  2005-10-13     Revised Date:  2005-11-16    
Medline Journal Info:
Nlm Unique ID:  100909716     Medline TA:  Ital Heart J     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  453-8     Citation Subset:  IM    
Affiliation:
Department of Cardiology, Isala Klinieken, De Weezenlanden Hospital, Zwolle, The Netherlands. g.deluca@diagram-zwolle.nl
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MeSH Terms
Descriptor/Qualifier:
Angioplasty, Transluminal, Percutaneous Coronary / methods*
Coronary Angiography
Coronary Care Units
Electrocardiography
Fibrinolytic Agents / therapeutic use
Humans
Myocardial Infarction / physiopathology,  radiography,  therapy*
Risk Assessment
Thrombolytic Therapy / methods*,  standards
Time Factors
Transportation of Patients / methods*
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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