A Comparison of Immediate Angioplasty with Thrombolytic Therapy for Acute Myocardial Infarction

Grines, Cindy L.; Browne, Kevin F.; Marco, Jean; Rothbaum, Donald A.; Stone, Gregg W.; O’Keefe, James H.; Overlie, Paul; Donohue, Bryan; Chelliah, Noah; Timmis, Gerald C.

doi:10.1056/nejm199303113281001

Cited by 1,797 publications

(678 citation statements)

References 34 publications

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“…There are insufficient data on the frequency of this event in the setting of acute ischemic stroke, although it has been described to occur 16% of the time in 1 series of elective angioplasty for intracranial atherosclerotic disease [64], but 0% of the time in small acute stroke series [65,66]. In the treatment of acute ST segment elevation myocardial infarction, balloon angioplasty alone is associated with abrupt closure 2.3 to 5% of the time with an approximately 10% ischemic event rate (i.e., reinfarction, death, or stroke) [67,68]. Clearly more data are needed on the safety and efficacy of this approach.…”

Section: Mechanical Clot Disruption and Extractionmentioning

confidence: 99%

Intra-arterial Therapy for Acute Ischemic Stroke

Aböu-Chebl

2011

Neurotherapeutics

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Intra-arterial therapy (IAT) for acute ischemic stroke refers to endovascular catheter-based approaches to achieve recanalization using mechanical clot disruption, locally injected thrombolytic agents or both. IAT may be used in addition to intravenous tissue plasminogen activator (tPA) or in patients who do not qualify for tPA, usually because they are outside the approved 3-h timeframe window or have contraindications, such as elevated international normalized ratio or partial thromboplastin time. Recanalization rates correlate with clinical improvement, and with the newest catheters it is possible to achieve recanalization in roughly 80% of patients treated. However, while the catheters are approved by the Food and Drug Administration, there are still no randomized trial data demonstrating the role of current IAT therapy vs either tPA or standard management. IAT is reserved for patients with large artery occlusions in the basilar, distal carotid, or proximal middle cerebral arteries. Imaging the penumbra using magnetic resonance imaging or computed tomographic perfusion is currently the most frequently used way to identify patients who might benefit. However, the imaging and clinical criteria for identifying which patients benefit, and perhaps more importantly those who will do poorly despite IAT, remain unclear.

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Section: Mechanical Clot Disruption and Extractionmentioning

confidence: 99%

Intra-arterial Therapy for Acute Ischemic Stroke

Aböu-Chebl

2011

Neurotherapeutics

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“…Analysis of 3 large randomized studies [12][13][14] comparing thrombolytic therapy with primary angioplasty, suggests advantages relative to mortality, intrahospital infarction, and morbidity, favoring the group of invasive measures. In the Primary Angioplasty in Myocardial Infarction (PAMI) study 12 , among 395 infarction patents, 150 (38%) were over 65 years. In these, a 6% mortality rate occurred in the group that underwent primary angioplasty and 15% for the group treated with thrombolytics, with a 0% and 6% incidence of cerebrovascular accidents, respectively.…”

Section: Discussionmentioning

confidence: 99%

Primary coronary angioplasty in a nonagenarian

Baracioli¹,

Serrano

Esteves

et al. 2002

Arq. Bras. Cardiol.

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A woman aged 98 years entered the tertiary hospital service with a picture of acute myocardial infarction of the extensive anterior wall, which began 4 hours earlier. Due to the large myocardial risk area suggested by the electrocardiogram, the patient was taken to the hemodynamics laboratory for the performance of emergency coronary arteriography, which revealed occlusion in the proximal third of the anterior descending artery. Primary angioplasty followed by stent grafting was successfully performed. The patient had a satisfactory evolution (Killip I) and was discharged from the hospital on the seventh postinfarction day. We discuss here aspects of thrombolysis and coronary percutaneous interventions in the aged

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“…Primary coronary angioplasty is one of the preferred methods of myocardial reperfusion performed without previous use of thrombolytic agents for the treatment of acute myocardial infarction [1][2][3][4][5] . It provides high levels of immediate arterial permeability with TIMI 3 optimal coronary flow 6 .…”

Section: Primary Coronary Angioplasty and Stent Implantation In Acutementioning

confidence: 99%

Primary coronary angioplasty and stent implantation in acute myocardial infarction. Comparative analysis of the in-hospital results in the CENIC/SBHCI registry

Mattos¹,

Sousa²,

Neto³

et al. 1999

Arq. Bras. Cardiol.

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Objective -Comparative analysis of the in-hospital results after primary implantation of stents or coronary balloon angioplasty in patients with acute myocardial infarction (MI). Methods -CENIC (National Center of Cardiovascular Interventions) gathered data on 3,924 patients undergoing coronary angioplasty (in the primary form, without the previous use of thrombolytic agents) in the first 24 hours after a MI, during the period of 1996 (6.3% vs. 4.5%, p=0.01), anterior MI and stent implantation in left descending artery (55% vs. 48% vs. p=0.009), and saphenous vein bypass grafts (3.3% vs. 1.9%). the procedure was more succesful in the group of stents (97% vs. 84%, p=0.001) and reinfarction rate (2.5 vs. 4%, p=0.002). The need for emergency revascularization was similar (1% vs. 1.1%, NS). Total in-hospital mortality was lower in stent group (3.4% vs. 7. 2%, p=0.0001) Primary coronary angioplasty is one of the preferred methods of myocardial reperfusion performed without previous use of thrombolytic agents for the treatment of acute myocardial infarction [1][2][3][4][5] . It provides high levels of immediate arterial permeability with TIMI 3 optimal coronary flow 6 . When available, it is comprehensive and offers a significant reduction in the occurrence of major immediate events, such as reinfarction, stroke, and death 3,5 .Results of randomized studies 7,8 , registries 9 , and consecutive series 10 , however, with the application of primary coronary angioplasty in acute myocardial infarction showed loss of immediate and late results in some subgroups of patients. In the in-hospital phase, the number of recurrent ischemias and reinfarctions was higher when suboptimal results were present (residual stenosis >30% and significant coronary dissection); at 6 months, restenosis and reocclusion of the vessel initially treated were as high as 45% and, in 25% of the cases, new myocardial revascularization procedures were performed , 9,10 .Coronary stent implantation in acute myocardial infarction is a recent therapeutical option aiming to optimize immediate and late results [11][12][13][14][15][16][17] , based on evidence observed in elective patients 18,19 .Our aim was to assess the in-hospital results of two techniques of percutaneous coronary revascularization in the acute phase of myocardial infarction: primary coronary stent implantation and conventional primary coronary balloon angioplasty. These two techniques are part of the national registry of procedures, CENIC (National Center of Cardiovascular Interventions), which belongs to the Sociedade Brasileira de Hemodinâmica e Cardiologia Intervencionista -SBHCI

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A Comparison of Immediate Angioplasty with Thrombolytic Therapy for Acute Myocardial Infarction

Abstract: As compared with t-PA therapy for acute myocardial infarction, immediate PTCA reduced the combined occurrence of nonfatal reinfarction or death, was associated with a lower rate of intracranial hemorrhage, and resulted in similar left ventricular systolic function.

Cited by 1,797 publications

References 34 publications

Intra-arterial Therapy for Acute Ischemic Stroke

Intra-arterial Therapy for Acute Ischemic Stroke

Primary coronary angioplasty in a nonagenarian

Primary coronary angioplasty and stent implantation in acute myocardial infarction. Comparative analysis of the in-hospital results in the CENIC/SBHCI registry

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