A prospective, placebo-controlled, randomized trial of intravenous streptokinase and angioplasty versus lone angioplasty therapy of acute myocardial infarction.

O’Neill, William W.; Weintraub, Richard; Grines, Cindy L.; Meany, Thomas B.; Brodie, Bruce R.; Friedman, Harold Z.; Ramos, Renato G.; Gangadharan, V.; Levin, Robert N.; Choksi, Nishit

doi:10.1161/01.cir.86.6.1710

Cited by 146 publications

(47 citation statements)

References 42 publications

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“…[1][2][3][4][5][19][20][21][22] It has been reported that rescue PTCA has a poor acute result, [23][24][25] so the combination of thrombolysis and mechanical angioplasty is not accepted as an established modality, despite several studies demonstrating that the effectiveness and safety of ICT prior to PTCA are enhanced in selected patients with a large thrombus. 26,27 Once angiographic no-flow occurs during the procedure, achieving flow restoration is not easy and if no-flow persists there is a poor prognosis.…”

Section: Discussionmentioning

confidence: 99%

Combined Revascularization Strategy for Acute Myocardial Infarction in Patients With Intracoronary Thrombus

et al. 2001

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rimary percutaneous transluminal coronary angioplasty (PTCA) for acute myocardial infarction (AMI) is a superior revascularization technique over systemic 1-4 or intracoronary 5 thrombolysis, although several limitations still remain, including a high reocclusion rate 6 or flow disturbance, 7,8 which influence the short 9,10 and long-term prognosis. 11 As is well known, the culprit lesion of AMI is usually a composite of atherosclerotic plaque and thrombus. [12][13][14] The thrombus burden varies from case to case, and large thrombus is resistant to systemic thrombolysis and frequently triggers distal embolization or 'no reflow' after mechanical revascularization. [15][16][17] Intracoronary thrombolysis (ICT) is a method of treating thrombus with a higher concentration of thrombolytic agent and potentially could enhance flow restoration when combined with PTCA. In the present study, we investigated this treatment method by comparing primary PTCA without preceding thrombolysis in AMI patients with intracoronary thrombus, focusing on acute phase flow restoration. Methods Study PopulationAmong 426 patients who received emergency PTCA for AMI between January 1988 and December 1996 in Kumamoto Central Hospital, 80 with an intracoronary thrombus Japanese Circulation Journal Vol.65, April 2001 on initial coronary angiography were enrolled in this retrospective analysis (Table 1). Patients who received systemic thrombolysis or who exhibited Thrombolysis in Myocardial Infarction (TIMI) grade 2/3 flow were excluded.Patients were also excluded if they displayed (1) stenosis of the left main coronary artery of more than 75%; or (2) critical 3-vessel disease. The diagnosis of AMI was based on typical chest pain lasting for at least 30 min, the appearance of ST-segment elevation of more than 2 mm in at least 2 contiguous ECG leads, and a greater than 3-fold increase in serum creatine kinase.Written informed consent for the need of revascularization had been obtained from each patient or from the family of the subject. DefinitionsIntracoronary thrombus was defined as a localized filling defect surrounded by contrast medium or as luminal staining at the site of a high-grade stenosis, which was visualized in multiple views clearly occupying more than 50% of the coronary artery lumen and more than 15 mm in length measured by the digital caliper method (DBAC-1000 NEOTEC Co, Ltd). In the case of total occlusion, the intracoronary thrombus was evaluated after crossing the occluded site with a 0.014-inch guidewire and/or noninflated balloon catheter. Preinfarction angina pectoris was defined as episodes of chest oppression/pain within 2 weeks of AMI onset. Cardiogenic shock at admission was defined as systolic blood pressure less than 80 mmHg that was unresponsive to volume expansion and necessitating immediate intraaortic balloon pump (IABP) therapy. Lesion success after PTCA was defined as residual stenosis less than 50% in the American Heart Association (AHA) classification

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Section: Discussionmentioning

confidence: 99%

Combined Revascularization Strategy for Acute Myocardial Infarction in Patients With Intracoronary Thrombus

et al. 2001

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“…Patients in cardiogenic shock were excluded or poorly represented in most trials. The fibrinolytic agent used was streptokinase in two trials (8,9), alteplase (rt-PA) in two trials (10,11) and tenecteplase (TNK) in three trials (12)(13)(14). In the ASSENT-4 and WEST studies (study acronyms are spelled out in Appendix 1), 20% and 40% of patients were enrolled in the prehospital setting, respectively.…”

Section: Pci Facilitated By Fibrinolytic Therapy Alonementioning

confidence: 99%

“…The risk of reinfarction was 2.0% to 7.0% with facilitated PCI and 1.0% to 3.7% with nonfacilitated PCI. In addition, facilitated PCI had no effect on the following surrogate end points: ST segment resolution at 60 min (GRACIA-2 [12], ADVANCE MI [15]), infarct size (GRACIA-2, BRAVE [16]), convalescent LVEF (SANI [8], PACT [10], PRAGUE-1 [17], GRACIA-2, BRAVE [16]), exercise stress test performance (PACT [10]) or MACE up to one year of follow-up (LIMI [11], PACT [10], PRAGUE-1 [18]). …”

Section: Pci Facilitated By Fibrinolytic Therapy Alonementioning

confidence: 99%

Systematic review of fibrinolytic-facilitated percutaneous coronary intervention: Potential benefits and future challenges

Afilalo

Roy

Eisenberg

2009

Canadian Journal of Cardiology

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P rimary percutaneous coronary intervention (PCI) has been shown to be superior to fibrinolytic therapy for the treatment of ST segment elevation myocardial infarction (STEMI) (1). However, primary PCI is suboptimal when there are prolonged delays for interhospital transfer or resource mobilization. Facilitated PCI is defined as the administration of fibrinolytic therapy and/or glycoprotein (GP) IIb/IIIa inhibitors while waiting for PCI. The rationale is to open infarctrelated arteries (IRAs) as soon as possible, minimize myocardial ischemia time and, thus, salvage at-risk myocardium. Despite the theoretical benefits, randomized controlled trials have failed to support the clinical benefits of this strategy. These trials varied substantially in terms of facilitating regimens, timing of fibrinolysis, timing of PCI, and coadministered antiplatelet or antithrombin therapies. A recent metaanalysis (2) showed that facilitated PCI was associated with increased short-term mortality, reinfarction, major bleeding and stroke. Although the results of this meta-analysis were unequivocally negative, a systematic review may be better suited to address these heterogeneous and complex trials. Our objective was to systematically review trials of fibrinolytic-facilitated versus nonfacilitated PCI, and determine when this strategy may be beneficial and deserving of further research. BACKGROUND: Facilitated percutaneous coronary intervention (PCI) is defined as the administration of fibrinolytic therapy and/or glycoprotein (GP) IIb/IIIa inhibitors to minimize myocardial ischemia time while waiting for PCI. A pooled meta-analysis suggested that facilitated PCI was associated with higher rates of mortality and morbidity compared with nonfacilitated PCI. OBJECTIVE: The heterogeneous and complex trials of facilitated PCI were systematically reviewed to identify where this strategy may be beneficial and deserving of further research. METHODS: MEDLINE, EMBASE, the Cochrane database, the Internet and conference proceedings were searched to obtain relevant trials. Human studies that randomly assigned patients to fibrinolytic-facilitated PCI (administration of fibrinolytic therapy alone or in combination with GP IIb/IIIa inhibitors before angiography) versus nonfacilitated PCI were included. RESULTS: Nine trials encompassing 3836 patients were reviewed. The facilitated PCI strategy was fibrinolytic therapy alone in seven trials and half-dose fibrinolytic therapy plus GP IIb/IIIa inhibitors in two trials. In patients who had fibrinolysis less than 2 h after symptom onset (mainly in the prehospital setting) and/or slightly delayed PCI 3 h to 24 h after fibrinolysis, facilitated PCI was associated with the greatest Thrombolysis In Myocardial Infarction (TIMI) grade 3 flow and a trend toward reduced mortality. Overall, facilitated PCI was associated with increased intracranial hemorrhage and reinfarction. Combining half-dose fibrinolytic therapy and GP IIb/IIIa inhibitors reduced reinfarction but increased major bleeding. CONCLUSIONS: Facilitat...

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“…A strategy of thrombolysis combined with transfer for immediate or early PCI was not supported by 3 level-1 randomized trials, 27-29 one level-2 30 and one level-7 trial, 31 and several nonrandomized studies or secondary analyses of trials. Several level-1 meta-analyses 32-34 also showed no benefit of immediate or early PCI.…”

Section: Studies Showing Neutral Effect or No Benefit By Qualitative mentioning

confidence: 99%

“…20,27 In some studies, patients in the control group routinely underwent delayed PCI, 21,28 whereas in others, patients in the control groups were treated medically unless they had spontaneous or inducible ischemia. 20,27 For studies in which all control-group patients underwent primary PCI, 14,26,31,40 no inference could be made on the efficacy of immediate or early angioplasty after thrombolysis compared with delayed angioplasty, and only the safety and feasibility of this approach was evaluated. The symmetry seen in the funnel plots and the large number of published studies with neutral or opposing results suggest that publication bias was unlikely to have had a major impact on the findings of this systematic overview.…”

Section: 45mentioning

confidence: 99%

Immediate angioplasty after thrombolysis: a systematic review

Cantor

Brunet²,

Ziegler³

et al. 2005

Canadian Medical Association Journal

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A prospective, placebo-controlled, randomized trial of intravenous streptokinase and angioplasty versus lone angioplasty therapy of acute myocardial infarction.

Cited by 146 publications

References 42 publications

Combined Revascularization Strategy for Acute Myocardial Infarction in Patients With Intracoronary Thrombus

Combined Revascularization Strategy for Acute Myocardial Infarction in Patients With Intracoronary Thrombus

Systematic review of fibrinolytic-facilitated percutaneous coronary intervention: Potential benefits and future challenges

Immediate angioplasty after thrombolysis: a systematic review

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